ONC 2015 Test Plan

This test plan is to be used for the ONC 2015 Edition Certification Testing of HealthIT modules. All test cases are required to be executed. The test plan includes a set of Administered Immunization test cases (Administration Group) and a set of Query and Response test cases (Evaluated History and Forecast Group).

Domain : Immunization

Version :

Contact :

Date : 2015-11-13 17:23:48

1. Administration Group

The administration group is design to test:

(1) the creation of a broad scope of immunization messages including support for new and historical administrations, refusals, combination vaccines, patient consent and various observations including VIS and VFC.

(2) the receipt and handling of various acknowledgement messages including application accept, application error, and application warning.

Test Cases consists of 2 steps:

(1) creating immunization messages based on the Immunization Messaging Standard (Z22 Profile) and specific Test Data, and

(2) receiving acknowledgment messages based on the Immunization Messaging Standard (Z23 Profile).

1.1. IZ-AD-1_Admin_Chlid

Maximally populated child administration

Test Story

Description
A child (infant) is seen at a clinic. Historical vaccinations are recorded and new vaccines are administered and documented.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message containing historical and new administrations for a child including next of kin, patient consent, VIS, funding source and VFC data.

Evaluation Criteria


Notes for Testers
No Note

1.1.1. IZ-AD-1.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
A two month old male infant, Russell Clinton Richardson, is brought to a clinic for a well child visit by his mother Maria Elizabeth Richardson (nee Billington) and his father John William Richardson. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient's vaccination history and determines that the child previously received Hepatitis B vaccine 1 day after birth and 1 month after birth. The staff member determines that the patient needs DTaP, Hib, IPV, Rotavirus and Pneumococcal vaccinations. Because of the patient's status of Native American, he qualifies for all Vaccine For Children (VFC) supplied vaccines under the status of VFC eligible - American Indian/Alaska Native. The parents are given 5 Vaccine Information Sheets (VIS) to review. After reading them, they agree that the child should receive all the vaccinations recommended. They also agree that the data should be shared once it is incorporated into the local IIS. Appropriate doses of DTaP/Hib/IPV (Pentacel), Rotavirus (RotaTeq) and Pneumococcal (Prevnar 13) are selected from the clinic's stock of publically funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
Message Validation Report

Notes for Testers
The NIST context-based testing performs specific content validation depending on the Category/Qualifier combination assigned to the Data Elements in the message (see How to Interpret the Message Content Data Sheet section for more details). In some cases, in order to perform this type of validation the NIST Tool expects the segments/segment groups in the message to be sequenced in a certain order (See example message). The complexity of automatically evaluating specific content necessitates this approach. If the Message Validation Result generated by the NIST Tool indicates content-related errors (designated by TCA), the ATL may change the order of the segments/segment groups in the test message to match the Test Case once the message has been loaded into the Message Content Edit window of the Test Tool. These kinds of content-related errors do not imply a failure of the vendor product nor a requirement to create the message with the segments/segment groups in a certain order (beyond the base message structure).

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID issApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624073733.994-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 12462 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 3123 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Richardson Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Russell Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Clint Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Billington Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20150415 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 1002-5 Presence-Content Indifferent
PID-10.2 Text American Indian or Alaska Native Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 543 Blount Drive Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5557690 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 07 Presence-Content Indifferent
PD1-11.2 Text Recall only - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20150415 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Richardson Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Maria Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 543 Blount Drive Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5557690 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Richardson Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name John Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof William Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier FTH Presence-Content Indifferent
NK1-3.2 Text Father Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 543 Blount Drive Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5558299 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 3140 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 38766 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 8681 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 65138 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7491 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 79539 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 9077 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31528 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 299 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 82668 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0560-05 Value-Test Case Fixed
RXA-5.2 Text Pentacel Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 526434 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150722 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4047-20 Value-Test Case Fixed
RXA-5.2 Text RotaTeq Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 2.0 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 297961 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150916 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-1971-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 13 Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 353480 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150729 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR Presence-Content Indifferent
RXA-17.2 Text Pfizer, Inc Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150416 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text Hep B, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150515 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text Hep B, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Presence-Content Indifferent
RXR-1.2 Text Oral Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier Presence-Content Indifferent
RXR-2.2 Text Presence-Content Indifferent
RXR-2.3 Name of Coding System Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Presence-Content Indifferent
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 5 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 5 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID issApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624073733.994-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 12462 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 3123 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Richardson Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Russell Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Clint Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Billington Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20150415 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 1002-5 Presence-Content Indifferent
PID-10.2 Text American Indian or Alaska Native Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 543 Blount Drive Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5557690 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 07 Presence-Content Indifferent
PD1-11.2 Text Recall only - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20150415 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1[*]
NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Richardson Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Maria Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 543 Blount Drive Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5557690 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 2 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Richardson Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name John Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof William Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier FTH Presence-Content Indifferent
NK1-3.2 Text Father Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 543 Blount Drive Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type CP Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5558299 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 3140 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 38766 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 8681 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 65138 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7491 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 79539 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 9077 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31528 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 299 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 82668 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0560-05 Value-Test Case Fixed
RXA-5.2 Text Pentacel Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 526434 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150722 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4047-20 Value-Test Case Fixed
RXA-5.2 Text RotaTeq Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 2.0 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 297961 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150916 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00005-1971-01 Value-Test Case Fixed
RXA-5.2 Text Prevnar 13 Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 353480 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150729 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PFR Presence-Content Indifferent
RXA-17.2 Text Pfizer, Inc Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150416 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text Hep B, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150515 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 45 Value-Test Case Fixed
RXA-5.2 Text Hep B, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38288 Presence-Content Indifferent
RXR-1.2 Text Oral Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier Presence-Content Indifferent
RXR-2.2 Text Presence-Content Indifferent
RXR-2.3 Name of Coding System Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Presence-Content Indifferent
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 5 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 5 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Russell Clint Richardson
Mother's Maiden Name Billington
ID Number 3123
Date/Time of Birth 04/15/2015
Administrative Sex Male
Patient Address 543 Blount Drive Bozeman MT 59715 USA
Local Number (406)555-7690
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/15/2015
Publicity Code Recall only - no calls
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Maria Elizabeth Richardson
Relationship Mother
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-7690

Guardian or Responsible Party
Element Data
Name John William Richardson
Relationship Father
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-8299

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code Pentacel
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 526434
Substance Expiration Date 07/22/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Polio VIS
Date Vis Presented 06/24/2015
Document Type Hepatitis B VIS
Date Vis Presented 06/24/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code RotaTeq
Date/Time Start of Administration 06/24/2015
Administered Amount 2.0
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 297961
Substance Expiration Date 09/16/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Oral
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Rotavirus VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code Prevnar 13
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 353480
Substance Expiration Date 07/29/2015
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Pneumococcal Conjugate (PCV13) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 04/16/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 05/15/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Patient Information
Element Data
Patient Name Russell Clint Richardson
Mother's Maiden Name Billington
ID Number 3123
Date/Time of Birth 04/15/2015
Administrative Sex Male
Patient Address 543 Blount Drive Bozeman MT 59715 USA
Local Number (406)555-7690
Race American Indian or Alaska Native
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/15/2015
Publicity Code Recall only - no calls
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party[*]
Guardian or Responsible Party
Element Data
Name Maria Elizabeth Richardson
Relationship Mother
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-7690

Guardian or Responsible Party
Element Data
Name John William Richardson
Relationship Father
Address 543 Blount Drive Bozeman MT 59715 USA
Phone Number (406)555-8299

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code Pentacel
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 526434
Substance Expiration Date 07/22/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Polio VIS
Date Vis Presented 06/24/2015
Document Type Hepatitis B VIS
Date Vis Presented 06/24/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code RotaTeq
Date/Time Start of Administration 06/24/2015
Administered Amount 2.0
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 297961
Substance Expiration Date 09/16/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Oral
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Rotavirus VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code Prevnar 13
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 353480
Substance Expiration Date 07/29/2015
Substance Manufacturer Name Pfizer, Inc
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - American Indian/Alaska Native
Document Type Pneumococcal Conjugate (PCV13) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 04/16/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information
Element Data
Administered Code Hep B, unspecified formulation
Date/Time Start of Administration 05/15/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.1.2. IZ-AD-1.2_Receive_ACK_Z23

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives
No Test Objectives

Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624073734.034-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 23628 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 12462 Presence-System Generated

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624073734.034-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 23628 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 12462 Presence-System Generated

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-1_Admin_Chlid
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.2. IZ-AD-2_Admin_Adult

Adult administration

Test Story

Description
An adult is seen at a clinic. Historical vaccinations are recorded and new vaccines are administered and documented.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message for an adult containing historical and new administrations including VIS and not eligible VFC.

Evaluation Criteria


Notes for Testers
No Note

1.2.1. IZ-AD-2.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
A 32 year old female, Elise Wong, visits a clinic for a well woman visit. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient's vaccination history and determines that Elise has received her influenza vaccinations on 10/12/2014 and 11/12/2013, but is in need of a tetanus booster. Because of the patient's age she does not qualify for Vaccine For Children (VFC) supplied vaccine. Elise is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees to receive the recommended vaccination. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Tdap (TENIVAC) is selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments

No Comments


Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives

Evaluation Criteria
Message Validation Report

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624084727.655-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 72268 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 90012 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Wong Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Elise Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 19830615 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2028-9 Presence-Content Indifferent
PID-10.2 Text Asian Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 9200 Wellington Trail Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address NonPresence
PID-13[1].6 Area/City Code 406 Presence-Content Indifferent
PID-13[1].7 Local Number 5557896 Presence-Content Indifferent
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type Internet Value-Test Case Fixed
PID-13[2].4 Email Address Elise.Wong@isp.com Presence-Content Indifferent
PID-13[2].6 Area/City Code NonPresence
PID-13[2].7 Local Number NonPresence
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 19830615 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 4422 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 13696 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 6139 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 38760 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7600 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 35508 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0215-88 Value-Test Case Fixed
RXA-5.2 Text TENIVAC Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 315841 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151216 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Presence-Content Indifferent
RXA-17.2 Text Sanofi Pasteur Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141012 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 88 Value-Test Case Fixed
RXA-5.2 Text influenza, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131112 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 88 Value-Test Case Fixed
RXA-5.2 Text influenza, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300028811150224
OBX-5.2 Text Tetanus/Diphtheria (Td) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624084727.655-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 72268 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 90012 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Wong Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Elise Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 19830615 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2028-9 Presence-Content Indifferent
PID-10.2 Text Asian Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 9200 Wellington Trail Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address NonPresence
PID-13[1].6 Area/City Code 406 Presence-Content Indifferent
PID-13[1].7 Local Number 5557896 Presence-Content Indifferent
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type Internet Value-Test Case Fixed
PID-13[2].4 Email Address Elise.Wong@isp.com Presence-Content Indifferent
PID-13[2].6 Area/City Code NonPresence
PID-13[2].7 Local Number NonPresence
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 19830615 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 4422 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 13696 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 6139 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 38760 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7600 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 35508 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 49281-0215-88 Value-Test Case Fixed
RXA-5.2 Text TENIVAC Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 315841 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151216 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier PMC Presence-Content Indifferent
RXA-17.2 Text Sanofi Pasteur Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141012 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 88 Value-Test Case Fixed
RXA-5.2 Text influenza, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20131112 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 88 Value-Test Case Fixed
RXA-5.2 Text influenza, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300028811150224
OBX-5.2 Text Tetanus/Diphtheria (Td) VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Elise Wong
Mother's Maiden Name
ID Number 90012
Date/Time of Birth 06/15/1983
Administrative Sex Female
Patient Address 9200 Wellington Trail Bozeman MT 59715 USA
Local Number (406)555-7896
Email Elise.Wong@isp.com
Race Asian
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/15/1983
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code TENIVAC
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 315841
Substance Expiration Date 12/16/2015
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Tetanus/Diphtheria (Td) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 10/12/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 11/12/2013
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Patient Information
Element Data
Patient Name Elise Wong
Mother's Maiden Name
ID Number 90012
Date/Time of Birth 06/15/1983
Administrative Sex Female
Patient Address 9200 Wellington Trail Bozeman MT 59715 USA
Local Number (406)555-7896
Email Elise.Wong@isp.com
Race Asian
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/15/1983
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code TENIVAC
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 315841
Substance Expiration Date 12/16/2015
Substance Manufacturer Name Sanofi Pasteur
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Tetanus/Diphtheria (Td) VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 10/12/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Vaccine Administration Information
Element Data
Administered Code influenza, unspecified formulation
Date/Time Start of Administration 11/12/2013
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.2.2. IZ-AD-2.2_Receive_ACK_Z23

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624084727.669-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 74602 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 72268 Presence-System Generated

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624084727.669-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 74602 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 72268 Presence-System Generated

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-2_Admin_Adult
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.3. IZ-AD-3_No_Consent

Child administration without consent for sharing. Also test the ability to send the patient's full first and middle names.

Test Story

Description
A child is seen at a clinic. A new vaccine is administered and documented but the information is not to shared by the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message for a child containing a new administration but an indication that the data should not be shared. Also test the ability of the EHR to support full first and middle names.

Evaluation Criteria


Notes for Testers
No Note

1.3.1. IZ-AD-3.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
An eleven and a half year old female, Katherine Mackenzie Benton, is brought to a clinic for a third and final dose of HPV vaccine. She is accompanied by her mother Kari Michelle Benton (nee Jones). A clinic staff member collects basic patient demographic information including name, date of birth and sex. The mother is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, the mother agrees that the child should receive the HPV vaccine, but she chooses not to share the data once it is incorporated into the local IIS. A clinic provider, Wilma Thomas (physician ID 654) places an order for the vaccination. While the patient is covered by insurance, the plan does not cover this vaccination and she qualifies for Vaccine For Children (VFC) supplied vaccines under the status of VFC eligible - Underinsured. An appropriate dose of HPV (CERVARIX) is selected from the clinic's stock of publically funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the dose to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
Support for no consent given
Support for a full middle name

Evaluation Criteria
Message Validation Report

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.804-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 77732 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 89778 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Benton Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Katherine Presence Length-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Mackenzie Presence Length-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Jones Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20031221 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5554019 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20031221 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Benton Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Kari Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Michelle Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5554019 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5237 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31309 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0830-05 Value-Test Case Fixed
RXA-5.2 Text CERVARIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 795441 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151223 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.804-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 77732 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 89778 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Benton Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Katherine Presence Length-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Mackenzie Presence Length-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Jones Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20031221 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5554019 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20031221 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Benton Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Kari Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Michelle Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5554019 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5237 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31309 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0830-05 Value-Test Case Fixed
RXA-5.2 Text CERVARIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 795441 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151223 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019

Vaccine Administration Information
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015

Patient Information
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019

Vaccine Administration Information
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015

1.3.2. IZ-AD-3.2_Receive_ACK_Z23

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.806-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 65657 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 77732 Presence-System Generated

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.806-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 65657 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 77732 Presence-System Generated

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-3_No_Consent
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.4. IZ-AD-4_Delete_Record

Child deleted administration

Test Story

Description
A child is seen at a clinic. A previously documented vaccination is deleted due to user error.

Comments
No Comments

Pre Condition
The IZ-AD-3_No_Consent test case has been successfully completed.

Post Condition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create a delete message for a previously sent administration.

Evaluation Criteria


Notes for Testers
No Note

1.4.1. IZ-AD-4.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
After administering an HPV vaccination to the eleven and a half year old female Katherine Benton the clinician, Lily Jackson (ID 7824) realizes that the vaccination was documented on the incorrect patient chart. She deletes the vaccination from the patient chart and transmits the change to the IIS.

Comments
No Comments

Pre Condition
The IZ-AD-3.1_Send_V04_Z22 test step has been successfully completed.

Post Condition
No PostCondition

Test Objectives
Support for sending delete requests.

Evaluation Criteria
Message Validation Report

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.804-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 71892 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 89778 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Benton Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Katherine Presence Length-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Mackenzie Presence Length-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Jones Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20031221 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5554019 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20031221 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Benton Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Kari Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Michelle Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5554019 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5237 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31309 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0830-05 Value-Test Case Fixed
RXA-5.2 Text CERVARIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 795441 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151223 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA D Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.804-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 71892 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 89778 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Benton Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Katherine Presence Length-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Mackenzie Presence Length-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Jones Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20031221 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5554019 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20031221 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Benton Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Kari Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Michelle Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 89 West 21st Ave Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5554019 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5237 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31309 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0830-05 Value-Test Case Fixed
RXA-5.2 Text CERVARIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 795441 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151223 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA D Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019

Vaccine Administration Information
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Delete
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015

Patient Information
Element Data
Patient Name Katherine Mackenzie Benton
Mother's Maiden Name Jones
ID Number 89778
Date/Time of Birth 12/21/2003
Administrative Sex Female
Patient Address 89 West 21st Ave Bozeman MT 59715 USA
Local Number (406)555-4019
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 12/21/2003
Publicity Code No reminder/recall
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Kari Michelle Benton
Relationship Mother
Address 89 West 21st Ave Bozeman MT 59715 USA
Phone Number (406)555-4019

Vaccine Administration Information
Element Data
Administered Code CERVARIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 795441
Substance Expiration Date 12/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Delete
Route Intramuscular
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Public
Vaccine Funding Program Eligibility VFC Eligible - Underinsured
Document Type Human papillomavirus Vaccine (Cervarix) VIS
Date Vis Presented 06/24/2015

1.4.2. IZ-AD-4.2_Receive_ACK_Z23

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.806-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 65657 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 71892 Presence-System Generated

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.806-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 65657 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 71892 Presence-System Generated

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-4_Delete_Record
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.5. IZ-AD-5_Refusal

Child administration with refusal. Also test multiple birth indicator.

Test Story

Description
The second child of a set of twins is seen at a clinic. A new vaccinations are administered but an additional one is refused by the parents.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
This test case assesses the ability of the EHR to create an administration message for child whose parents have refused an immunization and to support multiple birth indicator and order.

Evaluation Criteria


Notes for Testers
No Note

1.5.1. IZ-AD-5.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
A 1 year old male, Tyler Owen Banks, is brought to a clinic for a well child visit. He is accompanied by his father Karl Leonard Banks. Tyler's twin brother, born 5 minutes before Tyler, was not able to make it to the clinic. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Joe Smith (physician ID 123) reviews the patient's vaccination history and determines that the child requires Hib, Hep A, MMR and Varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The father is given the appropriate Vaccine Information Sheets (VIS) to review. After reading them, the father agrees that the child should receive the Hib, Hep A and MMR vaccines but refuses the Varicella vaccine. He also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of Hib (HIBERIX), Hep A (VAQTA) and MMR (M-M-R II) are selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 456) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
Message Validation Report

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.808-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 18019 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 8891 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Banks Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Tyler Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Owen Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20140602 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5555835 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20040602 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Banks Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Karl Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Leonard Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier FTH Presence-Content Indifferent
NK1-3.2 Text Father Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5555835 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5645 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 22515 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5027 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 12128 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7239 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 50588 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier Indifferent
ORC-2.2 Namespace ID Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID Indifferent
ORC-12.9.3 Universal ID Type Indifferent
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0806-01 Value-Test Case Fixed
RXA-5.2 Text HIBERIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 328734 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150923 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4095-01 Value-Test Case Fixed
RXA-5.2 Text VAQTA Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 208940 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160120 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4681-01 Value-Test Case Fixed
RXA-5.2 Text M-M-R II Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 134301 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151028 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 21 Value-Test Case Fixed
RXA-5.2 Text varicella Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier Indifferent
RXA-9.2 Text Indifferent
RXA-9.3 Name of Coding System Indifferent
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID Indifferent
RXA-10.9.3 Universal ID Type Indifferent
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00 Value-Test Case Fixed
RXA-18.2 Text Parental decision Presence-Content Indifferent
RXA-18.3 Name of Coding System NIP002 Value-Profile Fixed
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status RE Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Presence-Content Indifferent
RXR-1.2 Text Subcutaneous Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Presence-Content Indifferent
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411141022
OBX-5.2 Text Multiple Vaccines VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300012711120420
OBX-5.2 Text Measles/Mumps/Rubella VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.808-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 18019 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 8891 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Banks Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Tyler Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Owen Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20140602 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5555835 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20040602 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Banks Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Karl Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Leonard Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier FTH Presence-Content Indifferent
NK1-3.2 Text Father Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5555835 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5645 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 22515 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5027 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 12128 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7239 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 50588 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier Indifferent
ORC-2.2 Namespace ID Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID Indifferent
ORC-12.9.3 Universal ID Type Indifferent
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0806-01 Value-Test Case Fixed
RXA-5.2 Text HIBERIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 328734 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150923 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4095-01 Value-Test Case Fixed
RXA-5.2 Text VAQTA Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 208940 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160120 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4681-01 Value-Test Case Fixed
RXA-5.2 Text M-M-R II Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 134301 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151028 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 21 Value-Test Case Fixed
RXA-5.2 Text varicella Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier Indifferent
RXA-9.2 Text Indifferent
RXA-9.3 Name of Coding System Indifferent
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID Indifferent
RXA-10.9.3 Universal ID Type Indifferent
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier 00 Value-Test Case Fixed
RXA-18.2 Text Parental decision Presence-Content Indifferent
RXA-18.3 Name of Coding System NIP002 Value-Profile Fixed
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status RE Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Presence-Content Indifferent
RXR-1.2 Text Subcutaneous Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Presence-Content Indifferent
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300026411141022
OBX-5.2 Text Multiple Vaccines VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300004211111025
OBX-5.2 Text Hepatitis A VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300012711120420
OBX-5.2 Text Measles/Mumps/Rubella VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator Y
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code HIBERIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 328734
Substance Expiration Date 09/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Multiple Vaccines VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208940
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code M-M-R II
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 134301
Substance Expiration Date 10/28/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code varicella
Date/Time Start of Administration 06/24/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Patient Information
Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator Y
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator No
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code HIBERIX
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 328734
Substance Expiration Date 09/23/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Multiple Vaccines VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208940
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code M-M-R II
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 134301
Substance Expiration Date 10/28/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella VIS
Date Vis Presented 06/24/2015

Vaccine Administration Information
Element Data
Administered Code varicella
Date/Time Start of Administration 06/24/2015
Administered Amount 999
Administered Units
Administration Notes
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason Parental decision
Completion Status RE
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.5.2. IZ-AD-5.2_Recieve_ACK_Z23

Tests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.822-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 79946 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 18019 Presence-System Generated

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.822-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 79946 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 18019 Presence-System Generated

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-5_Refusal
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.6. IZ-AD-6_Update_Record

Child updated administration

Test Story

Description
A child is seen at a clinic. A previously documented vaccination is updated to correct inaccurate information..

Comments
No Comments

Pre Condition
The IZ-AD-5_Refusal test case has been successfully completed.

Post Condition
No PostCondition

Test Objectives
This test case asses the ability of the EHR to create an update message for a previously sent administration.

Evaluation Criteria


Notes for Testers
No Note

1.6.1. IZ-AD-6.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
After document vaccinations for Tyler Owen Banks the clinician, Lily Jackson (ID 456) recognizes that an error was made during data entry for the Hepatitis A vaccine. The Lot Number was entered incorrectly. She updates the data in the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
The IZ-AD-5.1_Send_V04_Z22 test step has been successfully completed.

Post Condition
No PostCondition

Test Objectives
Support for sending an update request.

Evaluation Criteria
Message Validation Report.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.808-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 18019 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 8891 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Banks Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Tyler Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Owen Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 20140602 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5555835 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20040602 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Banks Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Karl Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Leonard Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier FTH Presence-Content Indifferent
NK1-3.2 Text Father Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5555835 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5027 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 12128 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4095-01 Value-Test Case Fixed
RXA-5.2 Text VAQTA Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 208490 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160120 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA U Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.808-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 18019 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 8891 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Banks Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Tyler Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Owen Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 20140602 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5555835 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator Y Value-Test Case Fixed
PID-25 Birth Order 2 Value-Test Case Fixed
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 02 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150624 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20040602 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150624 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Banks Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Karl Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Leonard Presence-Content Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier FTH Presence-Content Indifferent
NK1-3.2 Text Father Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 924 Sycamore Lane Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5555835 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 5027 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 12128 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150624 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4095-01 Value-Test Case Fixed
RXA-5.2 Text VAQTA Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 208490 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20160120 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA U Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RT Presence-Content Indifferent
RXR-2.2 Text Right Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150624 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150624 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator Y
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835

Vaccine Administration Information
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208490
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Update
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

Patient Information
Element Data
Patient Name Tyler Owen Banks
Mother's Maiden Name
ID Number 8891
Date/Time of Birth 06/02/2014
Administrative Sex Male
Patient Address 924 Sycamore Lane Bozeman MT 59715 USA
Local Number (406)555-5835
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator Y
Birth Order 2
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/02/2004
Publicity Code Reminder/recall - any method
Publicity Code Effective Date 06/24/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/24/2015
Guardian or Responsible Party
Element Data
Name Karl Leonard Banks
Relationship Father
Address 924 Sycamore Lane Bozeman MT 59715 USA
Phone Number (406)555-5835

Vaccine Administration Information
Element Data
Administered Code VAQTA
Date/Time Start of Administration 06/24/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 208490
Substance Expiration Date 01/20/2016
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Update
Route Intramuscular
Administration Site Right Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis A VIS
Date Vis Presented 06/24/2015

1.6.2. IZ-AD-6.2_Receive_ACK_Z23

ests the ability to consume a valid ACK message

Test Story

Description
The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The acknowledgement message is consumed by the system responsible for the content of the administration message without error.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.822-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 79946 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 18019 Presence-System Generated

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150624093847.822-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 79946 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA Value-Test Case Fixed
MSA-2 Message Control ID 18019 Presence-System Generated

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-6_Update_Record
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system.

1.7. IZ-AD-7_Historical_IIS-Error

Historical administration resulting in fatal error

Test Story

Description
A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the acknowledgement message.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
The returned error must be visible in the EHR.

Test Objectives
This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal error being returned by the IIS.

Evaluation Criteria


Notes for Testers
No Note

1.7.1. IZ-AD-7.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
A 66 year old female, Helen Barrett, comes to a clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that she received a Zoster vaccination at a local pharmacy on her 65th birthday. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
Support for Sending Responsible Organization (MSH-22) and Receiving Responsible Organization (MSH-23).

Evaluation Criteria
Message Validation Report.

Notes for Testers
Tester should refer to the Message Content tab for expected elements needed to be valued in MSH-22 and MSH-23. Examples values are provided.

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625121047.839-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 35560 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 7120 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Barrett Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Helen Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 19500317 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 763 Main St Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address NonPresence
PID-13[1].6 Area/City Code 406 Presence-Content Indifferent
PID-13[1].7 Local Number 5554064 Presence-Content Indifferent
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Presence-Content Indifferent
PID-13[2].3 Telecommunication Equipment Type NonPresence
PID-13[2].4 Email Address Helen.Barrett@isp.com Presence-Content Indifferent
PID-13[2].6 Area/City Code NonPresence
PID-13[2].7 Local Number NonPresence
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 06 Presence-Content Indifferent
PD1-11.2 Text Recall only - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 19500317 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7646 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 53100 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID Indifferent
ORC-12.9.3 Universal ID Type Indifferent
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150317 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 121 Value-Test Case Fixed
RXA-5.2 Text zoster Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID Indifferent
RXA-10.9.3 Universal ID Type Indifferent
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625121047.839-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 35560 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 7120 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Barrett Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Helen Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 19500317 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 763 Main St Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address NonPresence
PID-13[1].6 Area/City Code 406 Presence-Content Indifferent
PID-13[1].7 Local Number 5554064 Presence-Content Indifferent
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Presence-Content Indifferent
PID-13[2].3 Telecommunication Equipment Type NonPresence
PID-13[2].4 Email Address Helen.Barrett@isp.com Presence-Content Indifferent
PID-13[2].6 Area/City Code NonPresence
PID-13[2].7 Local Number NonPresence
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 06 Presence-Content Indifferent
PD1-11.2 Text Recall only - any method Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator Y Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 19500317 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7646 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 53100 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID Indifferent
ORC-12.9.3 Universal ID Type Indifferent
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150317 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 121 Value-Test Case Fixed
RXA-5.2 Text zoster Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID Indifferent
RXA-10.9.3 Universal ID Type Indifferent
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

Test Data Specification

Patient Information
Element Data
Patient Name Helen Barrett
Mother's Maiden Name
ID Number 7120
Date/Time of Birth 03/17/1950
Administrative Sex Female
Patient Address 763 Main St Bozeman MT 59715 USA
Local Number (406)555-4064
Email Helen.Barrett@isp.com
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 03/17/1950
Publicity Code Recall only - any method
Publicity Code Effective Date 06/25/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/25/2015
Vaccine Administration Information
Element Data
Administered Code zoster
Date/Time Start of Administration 03/17/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Patient Information
Element Data
Patient Name Helen Barrett
Mother's Maiden Name
ID Number 7120
Date/Time of Birth 03/17/1950
Administrative Sex Female
Patient Address 763 Main St Bozeman MT 59715 USA
Local Number (406)555-4064
Email Helen.Barrett@isp.com
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 03/17/1950
Publicity Code Recall only - any method
Publicity Code Effective Date 06/25/2015
Protection Indicator Yes
Protection Indicator Effective Date 06/25/2015
Vaccine Administration Information
Element Data
Administered Code zoster
Date/Time Start of Administration 03/17/2015
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.7.2. IZ-AD-7.2_Receive_ACK_Z23

Tests the ability to consume an ACK message containing a fatal error

Test Story

Description
The IIS has a mapping error in their CVX table and is unable to recognize the CVX code sent in RXA-5 even though it is valid. The IIS is unable to identify the appropriate vaccine, which is a required element, and rejects the message. The acknowledgement message returned contains errors for the table mapping, missing required field (RXA-5) and missing required segment (RXA).

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The errors returned in the ACK message must be visible in the EHR.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625121047.853-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 20428 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE Value-Test Case Fixed
MSA-2 Message Control ID 35560 Presence-System Generated

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXA Value-Test Case Fixed
ERR-2.2 Segment Sequence 1 Value-Test Case Fixed
ERR-2.3 Field Position 5 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed List
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity E Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Vaccine code not recognized - message rejected Presence-Content Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625121047.853-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 20428 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE Value-Test Case Fixed
MSA-2 Message Control ID 35560 Presence-System Generated

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXA Value-Test Case Fixed
ERR-2.2 Segment Sequence 1 Value-Test Case Fixed
ERR-2.3 Field Position 5 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed List
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity E Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Vaccine code not recognized - message rejected Presence-Content Indifferent

Test Data Specification

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-7_Historical_IIS-Error
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

1.8. IZ-AD-8_Admin_IIS-Warning

New administration resulting in soft error

Test Story

Description
A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds a soft error (warning) which it returns in the acknowledgement message.

Comments
The test case simulates the IIS issuing an acknowledgement warning due to an internal warning even though the message is valid.

Pre Condition
No PreCondition

Post Condition
The returned warning must be visible in the EHR-S.

Test Objectives
The test case targets the EHR-S capability of supporting OIDs (e.g., in MSH-3 and for assigning authorities) for administered message and assesses the ability of the EHR-S to accept an acknowledgement message with a soft error (warning) being returned by the IIS.

Evaluation Criteria
Administered Message: Validation Report with no Errors
Acknowledgement Message: An indication of a warning (See Juror Document)

Notes for Testers
No Note

1.8.1. IZ-AD-8.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
A 1 month old female, Ashley Jennifer Broadbent, is brought to a clinic for a well child visit by her mother Ellen Broadbent (nee Layton). A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient's vaccination history and determines that the child requires a Hep B vaccination. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The mother is given the Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive the Hep B vaccine. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Hep B (ENGERIX-B) is selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives
Support of OIDs.

Evaluation Criteria
Message Validation Report.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.22 Presence-Configuration
MSH-3.3 Universal ID Type ISO Value-Profile Fixed
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.23 Presence-Configuration
MSH-4.3 Universal ID Type ISO Value-Profile Fixed
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Content Indifferent
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1 Indifferent
MSH-5.3 Universal ID Type ISO Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Content Indifferent
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2 Indifferent
MSH-6.3 Universal ID Type ISO Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625103328.757-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-AD-8.1_Send_V04_Z22 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-22.6.3 Universal ID Type ISO Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6478 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-23.6.3 Universal ID Type ISO Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-6478 Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 77100 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID NIST MPI Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Broadbent Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Ashley Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Layton Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20150516 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2054-5 Presence-Content Indifferent
PID-10.2 Text African American Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 901 North 12th St Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5552262 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20150516 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Broadbent Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Ellen Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 901 North 12th St Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5552262 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 3881 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 13926 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150625 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0820-01 Value-Test Case Fixed
RXA-5.2 Text ENGERIX-B Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 797397 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151203 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Presence-Content Indifferent
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911120202
OBX-5.2 Text Hepatitis B VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.22 Presence-Configuration
MSH-3.3 Universal ID Type ISO Value-Profile Fixed
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.23 Presence-Configuration
MSH-4.3 Universal ID Type ISO Value-Profile Fixed
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Content Indifferent
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1 Indifferent
MSH-5.3 Universal ID Type ISO Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Content Indifferent
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2 Indifferent
MSH-6.3 Universal ID Type ISO Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625103328.757-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-AD-8.1_Send_V04_Z22 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-22.6.3 Universal ID Type ISO Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6478 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-23.6.3 Universal ID Type ISO Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-6478 Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 77100 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID NIST MPI Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Broadbent Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Ashley Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Jennifer Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Layton Presence-Content Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code M Value-Profile Fixed
PID-7 Date/Time of Birth
PID-7.1 Time 20150516 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2054-5 Presence-Content Indifferent
PID-10.2 Text African American Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 901 North 12th St Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5552262 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 03 Presence-Content Indifferent
PD1-11.2 Text Reminder/recall - no calls Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20150516 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Broadbent Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Ellen Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier MTH Presence-Content Indifferent
NK1-3.2 Text Mother Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 901 North 12th St Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5552262 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 3881 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 13926 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150625 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0820-01 Value-Test Case Fixed
RXA-5.2 Text ENGERIX-B Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 797397 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151203 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LT Presence-Content Indifferent
RXR-2.2 Text Left Thigh Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier PHC70
OBX-5.2 Text Private
OBX-5.3 Name of Coding System CDCPHINVS
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier V01
OBX-5.2 Text Not VFC Eligible
OBX-5.3 Name of Coding System HL70064
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-5.1 Identifier 253088698300005911120202
OBX-5.2 Text Hepatitis B VIS
OBX-5.3 Name of Coding System cdcgs1vis
OBX-5.5 Alternate Text
OBX-5.6 Name of Alternate Coding System
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Ashley Jennifer Broadbent
Mother's Maiden Name Layton
ID Number 77100
Date/Time of Birth 05/16/2015
Administrative Sex Female
Patient Address 901 North 12th St Bozeman MT 59715 USA
Local Number (406)555-2262
Race African American
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 05/16/2015
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Guardian or Responsible Party
Element Data
Name Ellen Broadbent
Relationship Mother
Address 901 North 12th St Bozeman MT 59715 USA
Phone Number (406)555-2262

Vaccine Administration Information
Element Data
Administered Code ENGERIX-B
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 797397
Substance Expiration Date 12/03/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis B VIS
Date Vis Presented 06/25/2015

Patient Information
Element Data
Patient Name Ashley Jennifer Broadbent
Mother's Maiden Name Layton
ID Number 77100
Date/Time of Birth 05/16/2015
Administrative Sex Female
Patient Address 901 North 12th St Bozeman MT 59715 USA
Local Number (406)555-2262
Race African American
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 05/16/2015
Publicity Code Reminder/recall - no calls
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Guardian or Responsible Party
Element Data
Name Ellen Broadbent
Relationship Mother
Address 901 North 12th St Bozeman MT 59715 USA
Phone Number (406)555-2262

Vaccine Administration Information
Element Data
Administered Code ENGERIX-B
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 797397
Substance Expiration Date 12/03/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Thigh
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Hepatitis B VIS
Date Vis Presented 06/25/2015

1.8.2. IZ-AD-8.2_Receive_ACK_Z23

Tests the ability to consume an ACK message containing a warning

Test Story

Description
A mapping error in the IIS software results in the IIS being unable to recognize the administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains a warning for an invalid value.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The warning returned in the acknowledgement message is visible in the system responsible for the content of the administration message.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP Presence-Content Indifferent
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.1 Indifferent
MSH-3.3 Universal ID Type ISO Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC Presence-Content Indifferent
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.2 Indifferent
MSH-4.3 Universal ID Type ISO Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP Presence-Content Indifferent
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.22 Indifferent
MSH-5.3 Universal ID Type ISO Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility Presence-Content Indifferent
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.23 Indifferent
MSH-6.3 Universal ID Type ISO Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625103328.758-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 23842 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-1776 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-6482 Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE Value-Test Case Fixed
MSA-2 Message Control ID NIST-IZ-AD-8.1_Send_V04_Z22 Presence-System Generated

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR Value-Test Case Fixed
ERR-2.2 Segment Sequence 2 Value-Test Case Fixed
ERR-2.3 Field Position 1 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity W Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Administration Site not recognized - site data will not be saved Presence-Content Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP Presence-Content Indifferent
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.1 Indifferent
MSH-3.3 Universal ID Type ISO Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC Presence-Content Indifferent
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.2 Indifferent
MSH-4.3 Universal ID Type ISO Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP Presence-Content Indifferent
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.22 Indifferent
MSH-5.3 Universal ID Type ISO Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility Presence-Content Indifferent
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.23 Indifferent
MSH-6.3 Universal ID Type ISO Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625103328.758-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 23842 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-1776 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-6482 Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE Value-Test Case Fixed
MSA-2 Message Control ID NIST-IZ-AD-8.1_Send_V04_Z22 Presence-System Generated

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR Value-Test Case Fixed
ERR-2.2 Segment Sequence 2 Value-Test Case Fixed
ERR-2.3 Field Position 1 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity W Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Administration Site not recognized - site data will not be saved Presence-Content Indifferent

Test Data Specification

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-8_Admin_IIS-Warning
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

1.9. IZ-AD-9_Admin_IIS-2Warnings

New administration resulting in multiple soft errors

Test Story

Description
A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds multiple soft errors (warnings) which it returns in the acknowledgement message.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
The returned warnings must be visible in the EHR.

Test Objectives
This test case assesses the ability of the EHR to accept an acknowledgement message with multiple soft errors (warnings) being returned by the IIS.

Evaluation Criteria


Notes for Testers
No Note

1.9.1. IZ-AD-9.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
A 4 year old female, Lacy Wells, is brought to a clinic for a well child visit by her guardian Janelle Trudeau. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient's vaccination history and determines that the child requires DTaP, polio, MMR and varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The guardian is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive all the vaccines. She also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of DTap-IPV (KINRIX) and MMRV (ProQuad) are selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
Message Validation Report.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625115038.030-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 10746 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 22533 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Wells Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Lacy Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 20110430 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 12 North Oak St Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5552914 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20110430 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Trudeau Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Janelle Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier GRD Presence-Content Indifferent
NK1-3.2 Text Guardian Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 12 North Oak St Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5552914 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 657 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 68544 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7553 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 8671 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150625 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4171-01 Value-Test Case Fixed
RXA-5.2 Text ProQuad Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 407453 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151015 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150625 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0812-01 Value-Test Case Fixed
RXA-5.2 Text KINRIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 88402 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150730 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Presence-Content Indifferent
RXR-1.2 Text Subcutaneous Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LD Presence-Content Indifferent
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625115038.030-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 10746 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 22533 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Wells Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Lacy Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 20110430 Presence-Content Indifferent
PID-8 Administrative Sex F Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 12 North Oak St Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13 Phone Number - Home
PID-13.2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13.3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13.4 Email Address NonPresence
PID-13.6 Area/City Code 406 Presence-Content Indifferent
PID-13.7 Local Number 5552914 Presence-Content Indifferent
PID-22 Ethnic Group
PID-22.1 Identifier 2186-5 Presence-Content Indifferent
PID-22.2 Text Not Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20110430 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

NK1 : Next of Kin / Associated Parties
Location Data Element Data Categorization
NK1-1 Set ID - NK1 1 Value-Profile Fixed
NK1-2 Name
NK1-2.1 Family Name
NK1-2.1.1 Surname Trudeau Presence-Content Indifferent
NK1-2.1.2 Own Surname Prefix
NK1-2.1.3 Own Surname
NK1-2.1.4 Surname Prefix From Partner/Spouse
NK1-2.1.5 Surname From Partner/Spouse
NK1-2.2 Given Name Janelle Presence-Content Indifferent
NK1-2.3 Second and Further Given Names or Initials Thereof Indifferent
NK1-2.7 Name Type Code L Presence-Content Indifferent
NK1-3 Relationship
NK1-3.1 Identifier GRD Presence-Content Indifferent
NK1-3.2 Text Guardian Presence-Content Indifferent
NK1-3.3 Name of Coding System HL70063 Value-Profile Fixed
NK1-3.5 Alternate Text Indifferent
NK1-3.6 Name of Alternate Coding System Indifferent
NK1-4 Address
NK1-4.1 Street Address
NK1-4.1.1 Street or Mailing Address 12 North Oak St Presence-Content Indifferent
NK1-4.1.2 Street Name
NK1-4.1.3 Dwelling Number
NK1-4.2 Other Designation Indifferent
NK1-4.3 City Bozeman Presence-Content Indifferent
NK1-4.4 State or Province MT Presence-Content Indifferent
NK1-4.5 Zip or Postal Code 59715 Presence-Content Indifferent
NK1-4.6 Country USA Presence-Content Indifferent
NK1-4.7 Address Type P Presence-Content Indifferent
NK1-5 Phone Number
NK1-5.2 Telecommunication Use Code PRN Presence-Content Indifferent
NK1-5.3 Telecommunication Equipment Type PH Value-Test Case Fixed
NK1-5.4 Email Address NonPresence
NK1-5.6 Area/City Code 406 Presence-Content Indifferent
NK1-5.7 Local Number 5552914 Presence-Content Indifferent

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 657 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 68544 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 7553 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 8671 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number 654 Presence-Content Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Thomas Presence-Content Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Wilma Presence-Content Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Elizabeth Presence-Content Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code L Presence-Content Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code MD Presence-Content Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150625 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 00006-4171-01 Value-Test Case Fixed
RXA-5.2 Text ProQuad Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 407453 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20151015 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier MSD Presence-Content Indifferent
RXA-17.2 Text Merck and Co., Inc. Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20150625 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 58160-0812-01 Value-Test Case Fixed
RXA-5.2 Text KINRIX Presence-Content Indifferent
RXA-5.3 Name of Coding System NDC Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 0.5 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier mL Value-Test Case Fixed
RXA-7.2 Text mL Presence-Content Indifferent
RXA-7.3 Name of Coding System UCUM Value-Test Case Fixed
RXA-7.5 Alternate Text Indifferent
RXA-7.6 Name of Alternate Coding System Indifferent
RXA-9 Administration Notes
RXA-9.1 Identifier 00 Value-Test Case Fixed
RXA-9.2 Text New Record Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number 7824 Presence-Content Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Jackson Presence-Content Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Lily Presence-Content Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code L Presence-Content Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code PRN Presence-Content Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID wcEHR Presence-Content Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number 88402 Presence-Content Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time 20150730 Presence-Content Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier SKB Presence-Content Indifferent
RXA-17.2 Text GlaxoSmithKline Presence-Content Indifferent
RXA-17.3 Name of Coding System MVX Value-Test Case Fixed
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

RXR[*]
RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C38299 Presence-Content Indifferent
RXR-1.2 Text Subcutaneous Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier RD Presence-Content Indifferent
RXR-2.2 Text Right Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161 Presence-Content Indifferent
RXR-1.2 Text Intramuscular Presence-Content Indifferent
RXR-1.3 Name of Coding System NCIT Value-Profile Fixed
RXR-1.5 Alternate Text Indifferent
RXR-1.6 Name of Alternate Coding System Indifferent
RXR-2 Administration Site
RXR-2.1 Identifier LD Presence-Content Indifferent
RXR-2.2 Text Left Deltoid Presence-Content Indifferent
RXR-2.3 Name of Coding System HL70163 Value-Profile Fixed
RXR-2.5 Alternate Text Indifferent
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 30963-3 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Source Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 1 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 64994-7 Value-Test Case Fixed
OBX-3.2 Text Vaccine Funding Program Eligibility Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 2 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier VXC40 Value-Test Case Fixed
OBX-17.2 Text per immunization Presence-Content Indifferent
OBX-17.3 Name of Coding System CDCPHINVS Value-Profile Fixed
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 3 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5 Value-Profile Fixed
OBX-2 Value Type CE Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 69764-9 Value-Test Case Fixed
OBX-3.2 Text Document Type Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6 Value-Profile Fixed
OBX-2 Value Type DT Value-Test Case Fixed
OBX-3 Observation Identifier
OBX-3.1 Identifier 29769-7 Value-Test Case Fixed
OBX-3.2 Text Date Vis Presented Presence-Content Indifferent
OBX-3.3 Name of Coding System LN Value-Profile Fixed
OBX-3.5 Alternate Text Indifferent
OBX-3.6 Name of Alternate Coding System Indifferent
OBX-4 Observation Sub-ID 4 Presence-Content Indifferent
OBX-5 Observation Value 20150625 Presence-Content Indifferent
OBX-6 Units
OBX-6.1 Identifier Indifferent
OBX-6.2 Text Indifferent
OBX-6.3 Name of Coding System Indifferent
OBX-6.5 Alternate Text Indifferent
OBX-6.6 Name of Alternate Coding System Indifferent
OBX-11 Observation Result Status F Value-Profile Fixed
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20150625 Presence-System Generated
OBX-17 Observation Method
OBX-17.1 Identifier Indifferent
OBX-17.2 Text Indifferent
OBX-17.3 Name of Coding System Indifferent
OBX-17.5 Alternate Text Indifferent
OBX-17.6 Name of Alternate Coding System Indifferent

Test Data Specification

Patient Information
Element Data
Patient Name Lacy Wells
Mother's Maiden Name
ID Number 22533
Date/Time of Birth 04/30/2011
Administrative Sex Female
Patient Address 12 North Oak St Bozeman MT 59715 USA
Local Number (406)555-2914
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/30/2011
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Guardian or Responsible Party
Element Data
Name Janelle Trudeau
Relationship Guardian
Address 12 North Oak St Bozeman MT 59715 USA
Phone Number (406)555-2914

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code ProQuad
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 407453
Substance Expiration Date 10/15/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella/Varicella VIS
Date Vis Presented 06/25/2015

Vaccine Administration Information
Element Data
Administered Code KINRIX
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 88402
Substance Expiration Date 07/30/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Polio VIS
Date Vis Presented 06/25/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/25/2015

Patient Information
Element Data
Patient Name Lacy Wells
Mother's Maiden Name
ID Number 22533
Date/Time of Birth 04/30/2011
Administrative Sex Female
Patient Address 12 North Oak St Bozeman MT 59715 USA
Local Number (406)555-2914
Race White
Ethnic Group Not Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 04/30/2011
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Guardian or Responsible Party
Element Data
Name Janelle Trudeau
Relationship Guardian
Address 12 North Oak St Bozeman MT 59715 USA
Phone Number (406)555-2914

Vaccine Administration Information[*]
Vaccine Administration Information
Element Data
Administered Code ProQuad
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 407453
Substance Expiration Date 10/15/2015
Substance Manufacturer Name Merck and Co., Inc.
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Subcutaneous
Administration Site Right Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Measles/Mumps/Rubella/Varicella VIS
Date Vis Presented 06/25/2015

Vaccine Administration Information
Element Data
Administered Code KINRIX
Date/Time Start of Administration 06/25/2015
Administered Amount 0.5
Administered Units mL
Administration Notes New Record
Administering Provider Lily Jackson
Substance Lot Number 88402
Substance Expiration Date 07/30/2015
Substance Manufacturer Name GlaxoSmithKline
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route Intramuscular
Administration Site Left Deltoid
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By Wilma Thomas

Element Data
Vaccine Funding Source Private
Vaccine Funding Program Eligibility Not VFC Eligible
Document Type Polio VIS
Date Vis Presented 06/25/2015
Document Type Diphtheria/Tetanus/Pertussis (DTaP) VIS
Date Vis Presented 06/25/2015

1.9.2. IZ-AD-9.2_Receive_ACK_Z23

Tests the ability to consume an ACK message containing multiple warnings

Test Story

Description
A mapping error in the IIS software results in the IIS being unable to recognize either administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains warnings for the invalid values.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives
Handling of an ACK message returned by the IIS with multiple warnings.

Evaluation Criteria
The warnings returned in the acknowledgement message are visible in the system responsible for the content of the administration message.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625115038.044-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 29540 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE Value-Test Case Fixed
MSA-2 Message Control ID 10746 Presence-System Generated

ERR[*]
ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR Value-Test Case Fixed
ERR-2.2 Segment Sequence 1 Value-Test Case Fixed
ERR-2.3 Field Position 2 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity W Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Administration Site not recognized - site data will not be saved Presence-Content Indifferent

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR Value-Test Case Fixed
ERR-2.2 Segment Sequence 2 Value-Test Case Fixed
ERR-2.3 Field Position 2 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity W Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Administration Site not recognized - site data will not be saved Presence-Content Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625115038.044-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 29540 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AE Value-Test Case Fixed
MSA-2 Message Control ID 10746 Presence-System Generated

ERR[*]
ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR Value-Test Case Fixed
ERR-2.2 Segment Sequence 1 Value-Test Case Fixed
ERR-2.3 Field Position 2 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity W Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Administration Site not recognized - site data will not be saved Presence-Content Indifferent

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID RXR Value-Test Case Fixed
ERR-2.2 Segment Sequence 2 Value-Test Case Fixed
ERR-2.3 Field Position 2 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number 1 Value-Test Case Fixed
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 999 Value-Test Case Fixed
ERR-3.2 Text Application error Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity W Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier 5 Value-Test Case Fixed
ERR-5.2 Text Table value not found Presence-Content Indifferent
ERR-5.3 Name of Coding System HL70533 Value-Profile Fixed
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Administration Site not recognized - site data will not be saved Presence-Content Indifferent

Test Data Specification

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-9_Admin_IIS-2Warnings
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

1.10. IZ-AD-10_Historical_IIS-SysError

Historical administration resulting in system error

Test Story

Description
A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the acknowledgement message.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
The returned error must be visible in the EHR.

Test Objectives
This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal system error being returned by the IIS.

Evaluation Criteria


Notes for Testers
No Note

1.10.1. IZ-AD-10.1_Send_V04_Z22

Tests the ability to create a valid VXU^V04 message

Test Story

Description
A 68 year old male, Manuel Diego Vasquez, comes to a clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that he received a pneumococcal vaccination at a local pharmacy on October 21, 2014. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS.

Comments
No Comments

Pre Condition
No PreCondition

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
Message Validation Report.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625072816.601-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 41821 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 21142 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vasquez Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Manuel Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Diego Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 19470215 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 227 Park Ave Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address NonPresence
PID-13[1].6 Area/City Code 406 Presence-Content Indifferent
PID-13[1].7 Local Number 5555815 Presence-Content Indifferent
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type Internet Value-Test Case Fixed
PID-13[2].4 Email Address Manuel.Vasquez@isp.com Presence-Content Indifferent
PID-13[2].6 Area/City Code NonPresence
PID-13[2].7 Local Number NonPresence
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Presence-Content Indifferent
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20150625 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 4486 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31165 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141021 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 152 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal Conjugate, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID wcApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID iisApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID IIS Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625072816.601-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code VXU Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure VXU_V04 Value-Profile Fixed
MSH-10 Message Control ID 41821 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z22 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name wcEHR Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name IIS Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1 Value-Profile Fixed
PID-3 Patient Identifier List
PID-3.1 ID Number 21142 Presence-Content Indifferent
PID-3.3 Check Digit Scheme Indifferent
PID-3.4 Assigning Authority
PID-3.4.1 Namespace ID wcEHR Presence-Content Indifferent
PID-3.4.2 Universal ID Indifferent
PID-3.4.3 Universal ID Type Indifferent
PID-3.5 Identifier Type Code MR Presence-Content Indifferent
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Vasquez Presence-Content Indifferent
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Manuel Presence-Content Indifferent
PID-5.3 Second and Further Given Names or Initials Thereof Diego Presence-Content Indifferent
PID-5.7 Name Type Code L Presence-Content Indifferent
PID-6 Mother's Maiden Name
PID-6.1 Family Name
PID-6.1.1 Surname Indifferent
PID-6.1.2 Own Surname Prefix
PID-6.1.3 Own Surname
PID-6.1.4 Surname Prefix From Partner/Spouse
PID-6.1.5 Surname From Partner/Spouse
PID-6.7 Name Type Code Indifferent
PID-7 Date/Time of Birth
PID-7.1 Time 19470215 Presence-Content Indifferent
PID-8 Administrative Sex M Presence-Content Indifferent
PID-10 Race
PID-10.1 Identifier 2106-3 Presence-Content Indifferent
PID-10.2 Text White Presence-Content Indifferent
PID-10.3 Name of Coding System CDCREC Value-Profile Fixed
PID-10.5 Alternate Text Indifferent
PID-10.6 Name of Alternate Coding System Indifferent
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 227 Park Ave Presence-Content Indifferent
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation Indifferent
PID-11.3 City Bozeman Presence-Content Indifferent
PID-11.4 State or Province MT Presence-Content Indifferent
PID-11.5 Zip or Postal Code 59715 Presence-Content Indifferent
PID-11.6 Country USA Presence-Content Indifferent
PID-11.7 Address Type P Presence-Content Indifferent
PID-13[1] Phone Number - Home
PID-13[1].2 Telecommunication Use Code PRN Presence-Content Indifferent
PID-13[1].3 Telecommunication Equipment Type PH Value-Test Case Fixed
PID-13[1].4 Email Address NonPresence
PID-13[1].6 Area/City Code 406 Presence-Content Indifferent
PID-13[1].7 Local Number 5555815 Presence-Content Indifferent
PID-13[2] Phone Number - Home
PID-13[2].2 Telecommunication Use Code NET Value-Test Case Fixed
PID-13[2].3 Telecommunication Equipment Type Internet Value-Test Case Fixed
PID-13[2].4 Email Address Manuel.Vasquez@isp.com Presence-Content Indifferent
PID-13[2].6 Area/City Code NonPresence
PID-13[2].7 Local Number NonPresence
PID-22 Ethnic Group
PID-22.1 Identifier 2135-2 Presence-Content Indifferent
PID-22.2 Text Hispanic or Latino Presence-Content Indifferent
PID-22.3 Name of Coding System CDCREC Value-Profile Fixed
PID-22.5 Alternate Text Indifferent
PID-22.6 Name of Alternate Coding System Indifferent
PID-24 Multiple Birth Indicator N Presence-Content Indifferent
PID-25 Birth Order 1 Indifferent
PID-29 Patient Death Date and Time
PID-29.1 Time Indifferent
PID-30 Patient Death Indicator N Presence-Content Indifferent

PD1 : Patient Additional Demographic
Location Data Element Data Categorization
PD1-11 Publicity Code
PD1-11.1 Identifier 01 Presence-Content Indifferent
PD1-11.2 Text No reminder/recall Presence-Content Indifferent
PD1-11.3 Name of Coding System HL70215 Value-Profile Fixed
PD1-11.5 Alternate Text Indifferent
PD1-11.6 Name of Alternate Coding System Indifferent
PD1-12 Protection Indicator N Value-Test Case Fixed
PD1-13 Protection Indicator Effective Date 20150625 Presence-Content Indifferent
PD1-16 Immunization Registry Status A Presence-Content Indifferent
PD1-17 Immunization Registry Status Effective Date 20150625 Presence-Content Indifferent
PD1-18 Publicity Code Effective Date 20150625 Presence-Content Indifferent

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE Value-Profile Fixed
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier 4486 Presence-Content Indifferent
ORC-2.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-2.3 Universal ID Indifferent
ORC-2.4 Universal ID Type Indifferent
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 31165 Presence-Content Indifferent
ORC-3.2 Namespace ID wcEHR Presence-Content Indifferent
ORC-3.3 Universal ID Indifferent
ORC-3.4 Universal ID Type Indifferent
ORC-10 Entered By
ORC-10.1 ID Number 7824 Presence-Content Indifferent
ORC-10.2 Family Name
ORC-10.2.1 Surname Jackson Presence-Content Indifferent
ORC-10.2.2 Own Surname Prefix
ORC-10.2.3 Own Surname
ORC-10.2.4 Surname Prefix From Partner/Spouse
ORC-10.2.5 Surname From Partner/Spouse
ORC-10.3 Given Name Lily Presence-Content Indifferent
ORC-10.4 Second and Further Given Names or Initials Thereof Suzanne Presence-Content Indifferent
ORC-10.9 Assigning Authority
ORC-10.9.1 Namespace ID wcEHR Presence-Content Indifferent
ORC-10.9.2 Universal ID
ORC-10.9.3 Universal ID Type
ORC-10.10 Name Type Code L Presence-Content Indifferent
ORC-10.12 Check Digit Scheme Indifferent
ORC-10.13 Identifier Type Code PRN Presence-Content Indifferent
ORC-12 Ordering Provider
ORC-12.1 ID Number Indifferent
ORC-12.2 Family Name
ORC-12.2.1 Surname Indifferent
ORC-12.2.2 Own Surname Prefix
ORC-12.2.3 Own Surname
ORC-12.2.4 Surname Prefix From Partner/Spouse
ORC-12.2.5 Surname From Partner/Spouse
ORC-12.3 Given Name Indifferent
ORC-12.4 Second and Further Given Names or Initials Thereof Indifferent
ORC-12.9 Assigning Authority
ORC-12.9.1 Namespace ID Indifferent
ORC-12.9.2 Universal ID
ORC-12.9.3 Universal ID Type
ORC-12.10 Name Type Code Indifferent
ORC-12.12 Check Digit Scheme Indifferent
ORC-12.13 Identifier Type Code Indifferent
ORC-17 Entering Organization
ORC-17.1 Identifier wcEHR Presence-Content Indifferent
ORC-17.2 Text West Clinic Presence-Content Indifferent
ORC-17.3 Name of Coding System HL70362 Value-Profile Fixed
ORC-17.5 Alternate Text Indifferent
ORC-17.6 Name of Alternate Coding System Indifferent

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0 Value-Profile Fixed
RXA-2 Administration Sub-ID Counter 1 Value-Profile Fixed
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20141021 Presence-Content Indifferent
RXA-5 Administered Code
RXA-5.1 Identifier 152 Value-Test Case Fixed
RXA-5.2 Text Pneumococcal Conjugate, unspecified formulation Presence-Content Indifferent
RXA-5.3 Name of Coding System CVX Value-Test Case Fixed
RXA-5.5 Alternate Text Indifferent
RXA-5.6 Name of Alternate Coding System Indifferent
RXA-6 Administered Amount 999 Value-Test Case Fixed
RXA-7 Administered Units
RXA-7.1 Identifier NonPresence
RXA-7.2 Text NonPresence
RXA-7.3 Name of Coding System NonPresence
RXA-7.5 Alternate Text NonPresence
RXA-7.6 Name of Alternate Coding System NonPresence
RXA-9 Administration Notes
RXA-9.1 Identifier 01 Value-Test Case Fixed
RXA-9.2 Text Historical Administration Presence-Content Indifferent
RXA-9.3 Name of Coding System NIP001 Value-Profile Fixed
RXA-9.5 Alternate Text Indifferent
RXA-9.6 Name of Alternate Coding System Indifferent
RXA-10 Administering Provider
RXA-10.1 ID Number Indifferent
RXA-10.2 Family Name
RXA-10.2.1 Surname Indifferent
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Indifferent
RXA-10.4 Second and Further Given Names or Initials Thereof Indifferent
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID Indifferent
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code Indifferent
RXA-10.12 Check Digit Scheme Indifferent
RXA-10.13 Identifier Type Code Indifferent
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID Indifferent
RXA-11.4.2 Universal ID Indifferent
RXA-11.4.3 Universal ID Type Indifferent
RXA-15 Substance Lot Number Indifferent
RXA-16 Substance Expiration Date
RXA-16.1 Time Indifferent
RXA-17 Substance Manufacturer Name
RXA-17.1 Identifier Indifferent
RXA-17.2 Text Indifferent
RXA-17.3 Name of Coding System Indifferent
RXA-17.5 Alternate Text Indifferent
RXA-17.6 Name of Alternate Coding System Indifferent
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier Indifferent
RXA-18.2 Text Indifferent
RXA-18.3 Name of Coding System Indifferent
RXA-18.5 Alternate Text Indifferent
RXA-18.6 Name of Alternate Coding System Indifferent
RXA-20 Completion Status CP Value-Test Case Fixed
RXA-21 Action Code - RXA A Value-Test Case Fixed

Test Data Specification

Patient Information
Element Data
Patient Name Manuel Diego Vasquez
Mother's Maiden Name
ID Number 21142
Date/Time of Birth 02/15/1947
Administrative Sex Male
Patient Address 227 Park Ave Bozeman MT 59715 USA
Local Number (406)555-5815
Email Manuel.Vasquez@isp.com
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/25/2015
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Vaccine Administration Information
Element Data
Administered Code Pneumococcal Conjugate, unspecified formulation
Date/Time Start of Administration 10/21/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

Patient Information
Element Data
Patient Name Manuel Diego Vasquez
Mother's Maiden Name
ID Number 21142
Date/Time of Birth 02/15/1947
Administrative Sex Male
Patient Address 227 Park Ave Bozeman MT 59715 USA
Local Number (406)555-5815
Email Manuel.Vasquez@isp.com
Race White
Ethnic Group Hispanic or Latino
Multiple Birth Indicator N
Birth Order 1
Immunization Registry Information
Element Data
Immunization Registry Status A
Immunization Registry Status Effective Date 06/25/2015
Publicity Code No reminder/recall
Publicity Code Effective Date 06/25/2015
Protection Indicator No
Protection Indicator Effective Date 06/25/2015
Vaccine Administration Information
Element Data
Administered Code Pneumococcal Conjugate, unspecified formulation
Date/Time Start of Administration 10/21/2014
Administered Amount 999
Administered Units
Administration Notes Historical Administration
Administering Provider
Substance Lot Number
Substance Expiration Date
Substance Manufacturer Name
Substance/Treatment Refusal Reason
Completion Status CP
Action Code Add
Route
Administration Site
Entering Organization West Clinic
Entered By Lily Jackson
Ordered By

1.10.2. IZ-AD-10.2_Receive_ACK_Z23

Tests the ability to consume an ACK message containing a system error

Test Story

Description
Due to an error in the IIS software, the IIS is unable to recognize the HL7 version ID sent in MSH-12 even though it is valid. The acknowledgement message returned contains an error for an unsupported version ID.

Comments
No Comments

Pre Condition
A VXU message is generated by the EHR.

Post Condition
No PostCondition

Test Objectives


Evaluation Criteria
The error returned in the acknowledgement message is visible in the system responsible for the content of the administration message.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625072816.602-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 48026 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AR Value-Test Case Fixed
MSA-2 Message Control ID 41821 Presence-System Generated

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID MSH Value-Test Case Fixed
ERR-2.2 Segment Sequence 12 Value-Test Case Fixed
ERR-2.3 Field Position 1 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number Indifferent
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 203 Value-Test Case Fixed
ERR-3.2 Text Unsupported Version ID Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity E Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier Indifferent
ERR-5.2 Text Indifferent
ERR-5.3 Name of Coding System Indifferent
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Version ID not recognized - message rejected Presence-Content Indifferent

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID iisApp Presence-Content Indifferent
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID IIS Presence-Content Indifferent
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID wcApp Presence-Content Indifferent
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID wcEHR Presence-Content Indifferent
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150625072816.602-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code ACK Value-Profile Fixed
MSH-9.2 Trigger Event V04 Value-Profile Fixed
MSH-9.3 Message Structure ACK Value-Profile Fixed
MSH-10 Message Control ID 48026 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type NE Value-Profile Fixed
MSH-16 Application Acknowledgment Type NE Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z23 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Test Case Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name IIS Presence-Content Indifferent
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code Indifferent
MSH-22.10 Organization Identifier Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name wcEHR Presence-Content Indifferent
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code Indifferent
MSH-23.10 Organization Identifier Indifferent

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AR Value-Test Case Fixed
MSA-2 Message Control ID 41821 Presence-System Generated

ERR : Error
Location Data Element Data Categorization
ERR-2 Error Location
ERR-2.1 Segment ID MSH Value-Test Case Fixed
ERR-2.2 Segment Sequence 12 Value-Test Case Fixed
ERR-2.3 Field Position 1 Value-Test Case Fixed
ERR-2.4 Field Repetition 1 Value-Test Case Fixed
ERR-2.5 Component Number Indifferent
ERR-2.6 Sub-Component Number Indifferent
ERR-3 HL7 Error Code
ERR-3.1 Identifier 203 Value-Test Case Fixed
ERR-3.2 Text Unsupported Version ID Presence-Content Indifferent
ERR-3.3 Name of Coding System HL70357 Value-Profile Fixed
ERR-3.5 Alternate Text Indifferent
ERR-3.6 Name of Alternate Coding System Indifferent
ERR-4 Severity E Value-Test Case Fixed
ERR-5 Application Error Code
ERR-5.1 Identifier Indifferent
ERR-5.2 Text Indifferent
ERR-5.3 Name of Coding System Indifferent
ERR-5.5 Alternate Text Indifferent
ERR-5.6 Name of Alternate Coding System Indifferent
ERR-8 User Message Version ID not recognized - message rejected Presence-Content Indifferent

Test Data Specification

Juror Document

Return an Acknowledgement
Test Case ID IZ-AD-10_Historical_IIS-SysError
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.

The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.



Return an Acknowledgement

The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system.

2. Evaluated History and Forecast Group

Test the EHR-S capability to:
This set of tests evaluates the EHR-S's ability to create well-formed queries and gracefully accept the response messages. It evaluates that the clinician is shown the results of the query. The possibilities include: (1) evaluated history and forecast (2) too many patients found, or (3) no patients found. A juror document (inspection check list) is provided that indicates the content that is expected to be displayed.

Test Cases consists of 2 steps:

(1) create query messages based on Immunization Messaging Standard (Z44 Profile) and specific Test Data, and

(2) receive (Z42 Profile) messages and display evaluated history and forecast OR receive (Z33 Profile) and? display too many patients found or no patients found.

2.1. IZ-QR-1_Query_Child

Query for a child with immunization history. A response message with evaluated history and forecast is returned.

Test Story

Description
A male child patient, Bobbie Q. Child, is brought to the clinic for an annual visit. A staff person locates his medical record in the EHR-S. The staff person confirms demographic information, including address. The staff person triggers a request to the IIS for an evaluated history and forecast for the child. The IIS performs a search for Bobbie Q. Child and finds one high-confidence match. The IIS generates an evaluated history and forecast for Bobbie and returns this to the EHR-S. One dose of vaccine was not administrated at the correct age and is marked as not valid. The EHR-S displays the evaluated history and forecast, including the not valid dose.

Comments
No Comments

Pre Condition
Person exists in the querying system with the complete demographics as provided in the Test Data Specification.
Person has Medical Record Number (MR).
Person does not have existing immunization events in their EHR.
Person does have an immunization history in the IIS (simulated by the NIST Test Tool).

Post Condition
The clinician is able to view the evaluated history and forecast from the IIS. There is no obligation to incorporate the data into the EHR-S or maintain the displayed evaluated history and forecast.

Test Objectives
Evaluates EHR-S ability to create a well formed query for a child. Evaluates EHR-S ability to accept and display a response with evaluated history and forecast for that person.

Evaluation Criteria
Tester inspects patient record; confirms that the patients does not have existing immunization events.
Confirms valid query message using Message Validation Report.
Confirms valid receipt and display of response message using the Juror Document.

Notes for Testers
The NIST tool is simulating a response from the IIS.

2.1.1. IZ-QR-1.1_Query_Q11_Z44

Query requests an evaluated history and forecast for a young adult

Test Story

Description
A male child patient, Bobbie Q. Child, is brought to the clinic for an annual visit. A staff person locates his medical record in the EHR-S. The staff person confirms demographic information, including address. The Staff person triggers a request to the IIS for an evaluated history and forecast for the child.

Comments
Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record.

Pre Condition
Person exists in the system with the complete demographics as provided in the Test Data Specification.
Person has Medical Record Number (MR).
Person does not have existing immunization events in their EHR.
Person does have an immunization history in the IIS.

Post Condition
The IIS return an evaluated history and forecast for the person.

Test Objectives
Test the ability of the system to successfully create a query message based on the given test data.

Evaluation Criteria
Tester inspects patient record; confirms that the patients does not have existing immunization events.
Confirms valid query message using Message Validation Report.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-QR-1.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST EHR Facility Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6482 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST IIS FAC Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-1776 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-1.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 171122 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID Indifferent
QPD-3.4.3 Universal ID Type Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Child Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Bobbie Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Q Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Que Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20090214 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 105 Laurel Run Rd Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Indifferent
QPD-8.3 City Bozeman Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code Value-Test Case Fixed
QPD-8.6 Country Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code Value-Test Case Fixed
QPD-9.7 Local Number Value-Test Case Fixed
QPD-10 Multiple birth indicator Value-Test Case Fixed
QPD-11 Birth order Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-QR-1.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST EHR Facility Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6482 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST IIS FAC Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-1776 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-1.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 171122 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID Indifferent
QPD-3.4.3 Universal ID Type Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Child Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Bobbie Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Q Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Que Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20090214 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 105 Laurel Run Rd Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Indifferent
QPD-8.3 City Bozeman Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code Value-Test Case Fixed
QPD-8.6 Country Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code Value-Test Case Fixed
QPD-9.7 Local Number Value-Test Case Fixed
QPD-10 Multiple birth indicator Value-Test Case Fixed
QPD-11 Birth order Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Bobbie Q Child
Mother's Maiden Name Que
ID Number 171122
Date/Time of Birth 02/14/2009
Sex Male
Patient Address 105 Laurel Run Rd Bozeman MT
Patient Phone
Birth Indicator
Birth Order
Patient Information
Element Data
Patient Name Bobbie Q Child
Mother's Maiden Name Que
ID Number 171122
Date/Time of Birth 02/14/2009
Sex Male
Patient Address 105 Laurel Run Rd Bozeman MT
Patient Phone
Birth Indicator
Birth Order

2.1.2. IZ-QR-1.2_Response_K11_Z42

No Description

Test Story

Description
The IIS performs a search for Bobbie Q. Child and finds one high-confidence match. The IIS generates an evaluated history and forecast for Bobbie and returns this to the EHR-S. One dose of vaccine was not administrated at the correct age and is marked as not valid. The EHR-S displays the evaluated history and forecast, including the not valid dose.

Comments
No Comments

Pre Condition
A query is performed by the sending system. The IIS (simulated by the NIST test tool) contains an immunization events for the person.

Post Condition
The response is made available to the EHR-S for processing. The clinician is able to view the evaluated history and forecast from the IIS. There is no obligation to incorporate the data into the EHR-S or maintain the displayed evaluated history and forecast.

Test Objectives
Receive a response message containing the evaluated history and forecast; display evaluated history and forecast.

Evaluation Criteria
Confirms valid receipt and display of response message using the Juror Document.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20151031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-1.2_Response_K11_Z42
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-1.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-1.1-2015
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 107374859
QPD-3 PatientList
QPD-3.1 ID Number 171122
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Child
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Bobbie
QPD-4.3 Second and Further Given Names or Initials Thereof Q
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Que
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20090214
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 105 Laurel Run Rd
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Bozeman
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code
QPD-9.3 Telecommunication Equipment Type
QPD-9.4 Email Address
QPD-9.6 Area/City Code
QPD-9.7 Local Number
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 171122
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID NIST MPI
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 34500907
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MyIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Child
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Bobbie
PID-5.3 Second and Further Given Names or Initials Thereof Q
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 20090214
PID-8 Administrative Sex M
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 105 Laurel Run Rd
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Bozeman
PID-11.4 State or Province MT
PID-11.5 Zip or Postal Code
PID-11.6 Country
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID NIST-AA-1
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier wc
ORC-17.2 Text West Clinic
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier DCS
ORC-17.2 Text Dabig Clinical System
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20090415
RXA-5 Administered Code
RXA-5.1 Identifier 31
RXA-5.2 Text Hep B Peds NOS
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historical record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20090314
RXA-5 Administered Code
RXA-5.1 Identifier 48
RXA-5.2 Text HIB PRP-T
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sticker
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Nurse
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091011
RXA-5 Administered Code
RXA-5.1 Identifier 110
RXA-5.2 Text DTAP-Hep B-IPV
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100411
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hep BPEDS
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sticker
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Nurse
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100415
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text MMR
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type ST
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason applied
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Too Young
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20151031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-1.2_Response_K11_Z42
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-1.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-1.1-2015
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag 107374859
QPD-3 PatientList
QPD-3.1 ID Number 171122
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Child
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Bobbie
QPD-4.3 Second and Further Given Names or Initials Thereof Q
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Que
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20090214
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 105 Laurel Run Rd
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Bozeman
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code
QPD-9.3 Telecommunication Equipment Type
QPD-9.4 Email Address
QPD-9.6 Area/City Code
QPD-9.7 Local Number
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 171122
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID NIST MPI
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 34500907
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID MyIIS
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Child
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Bobbie
PID-5.3 Second and Further Given Names or Initials Thereof Q
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 20090214
PID-8 Administrative Sex M
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 105 Laurel Run Rd
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Bozeman
PID-11.4 State or Province MT
PID-11.5 Zip or Postal Code
PID-11.6 Country
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197023
ORC-3.2 Namespace ID NIST-AA-1
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier wc
ORC-17.2 Text West Clinic
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197027
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 197028
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier DCS
ORC-17.2 Text Dabig Clinical System
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20090415
RXA-5 Administered Code
RXA-5.1 Identifier 31
RXA-5.2 Text Hep B Peds NOS
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historical record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20090314
RXA-5 Administered Code
RXA-5.1 Identifier 48
RXA-5.2 Text HIB PRP-T
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sticker
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Nurse
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091011
RXA-5 Administered Code
RXA-5.1 Identifier 110
RXA-5.2 Text DTAP-Hep B-IPV
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100411
RXA-5 Administered Code
RXA-5.1 Identifier 08
RXA-5.2 Text Hep BPEDS
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sticker
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Nurse
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20100415
RXA-5 Administered Code
RXA-5.1 Identifier 03
RXA-5.2 Text MMR
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 01
RXA-9.2 Text historic immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20091031
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type ST
OBX-3 Observation Identifier
OBX-3.1 Identifier 30982-3
OBX-3.2 Text Reason applied
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Too Young
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value N
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 20100214
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151031

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID IZ-QR-1_Query_Child
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
171122 Bobbie Q Child 02/14/2009 Male
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History and Immunization Forecast
Immunization Schedule Used Tester Comment
ACIP


Evaluated Immunization History
Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment
Hep B NOS Hep B Peds NOS 04/15/2009 YES Complete
HIB NOS HIB PRP-T 03/14/2009 NO Too Young Complete
Hep B NOS DTAP-Hep B-IPV 10/11/2009 YES Complete
IPV DTAP-Hep B-IPV 10/11/2009 YES Complete
DTAP DTAP-Hep B-IPV 10/11/2009 YES Complete
Hep B NOS Hep BPEDS 04/11/2010 YES Complete
MMR MMR 04/15/2010 NO Complete
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Due Date Earliest Date To Give Latest Date to Give Tester Comment
MMR 02/14/2010 02/14/2010
IPV 02/14/2010
DTAP 02/14/2010

2.2. IZ-QR-2_Query_Adult

Query for an adult using the most significant query parameters. The patient is found in the IIS. A response message is returned with a signal immunization event and multiple immunization recomendations.

Test Story

Description
Query for an adult using the most significant query parameters. The patient is found in the IIS. A response message is returned with a single immunization event and multiple immunization recommendations.
An adult male patient, Stanley S. Clement presents to the clinic, seeking an immunization for influenza. A clinic staff member locates his medical record in the electronic health record system. The staff member sees that he has previously had an immunization against influenza. The staff member triggers a request to the IIS to request an evaluated history and forecast for the patient. The IIS performs a search for Stanley S. Clement and finds one high confidence match. The IIS generates an evaluated history and forecast for Mr. Clement and returns this to the EHR-S. The EHR-S displays the evaluated history and forecast to the staff member.

Comments
No Comments

Pre Condition
Person exists in the system with the complete demographics as provided in the Test Data Specification.
Person has Medical Record Number (MR).
Person does not have existing immunization events in their EHR.
Person does have an immunization history in the IIS,

Post Condition
The clinician is able to view the evaluated history and forecast from the IIS. There is no obligation to incorporate the data into the EHR-S or maintain the displayed evaluated history and forecast.

Test Objectives
Evaluates EHR-S ability to create a well formed query for an adult. Evaluates EHR-S ability to accept a response with evaluated history and forecast for that person.

Evaluation Criteria
  1. Tester inspects patient record; confirms that the patients does not have existing immunization events.
  2. Confirms valid query message using Message Validation Report.
  3. Confirms valid receipt and display of response message using the Juror Document.

Notes for Testers
The NIST tool is simulating a response from the IIS.

2.2.1. IZ-QR-2.1_Query_Q11_Z44

No Description

Test Story

Description
An adult male patient, Stanley S. Clement presents to the clinic, seeking an immunization for influenza. A clinic staff member locates his medical record in the electronic health record system. The staff member sees that he has previously had an immunization against influenza. The staff member triggers a request to the IIS to request an evaluated history and forecast for the patient.

Comments
Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record.

Pre Condition
Person exists in the querying system with the complete demographics as provided in the Test Data Specification.
Person has Medical Record Number (MR).
Person does not have existing immunization events in their EHR.
Person does have an immunization history in the IIS (simulated by the NIST Test Tool).

Post Condition
IIS returns a response message for the person containing a single immunization event and multiple recommendations.

Test Objectives
Test the ability of the system to successfully create a query message based on the given test data.

Evaluation Criteria
Tester inspects patient record; confirms that the patients does not have existing immunization events.
Confirms valid query message using Message Validation Report.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-QR-2.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST EHR Facility Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6482 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST IIS FAC Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-1776 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-2.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 648286 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID Indifferent
QPD-3.4.3 Universal ID Type Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Stanley Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Clement Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof S Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Smith Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 19500214 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 1642 Bear Run Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Indifferent
QPD-8.3 City Boseman Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 59715 Value-Test Case Fixed
QPD-8.6 Country USA Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406 Value-Test Case Fixed
QPD-9.7 Local Number 5552020 Value-Test Case Fixed
QPD-10 Multiple birth indicator Value-Test Case Fixed
QPD-11 Birth order Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-QR-2.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST EHR Facility Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6482 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST IIS FAC Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-1776 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-2.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 648286 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID Indifferent
QPD-3.4.3 Universal ID Type Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Stanley Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Clement Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof S Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Smith Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 19500214 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 1642 Bear Run Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Indifferent
QPD-8.3 City Boseman Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 59715 Value-Test Case Fixed
QPD-8.6 Country USA Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406 Value-Test Case Fixed
QPD-9.7 Local Number 5552020 Value-Test Case Fixed
QPD-10 Multiple birth indicator Value-Test Case Fixed
QPD-11 Birth order Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Clement S Stanley
Mother's Maiden Name Smith
ID Number 648286
Date/Time of Birth 02/14/1950
Sex Male
Patient Address 1642 Bear Run Boseman MT 59715 USA
Patient Phone (406)555-2020
Birth Indicator
Birth Order
Patient Information
Element Data
Patient Name Clement S Stanley
Mother's Maiden Name Smith
ID Number 648286
Date/Time of Birth 02/14/1950
Sex Male
Patient Address 1642 Bear Run Boseman MT 59715 USA
Patient Phone (406)555-2020
Birth Indicator
Birth Order

2.2.2. IZ-QR-2.2_Response_K11_Z42

return response to query for an adult with historical smallpox vaccination

Test Story

Description
The IIS performs a search for Stanley S. Clement and finds one high confidence match. The IIS generates an evaluated history and forecast for Mr. Clement and returns this to the EHR-S. The EHR-S displays the evaluated history and forecast to the staff member.

Comments
No Comments

Pre Condition
A query is performed by the sending system. The IIS (simulated by the NIST test tool) contains an immunization events for the person.

Post Condition
The response is made available to the EHR-S for processing. The clinician is able to view the evaluated history and forecast from the IIS (even if temporal).

Test Objectives
Demonstrate the capability to receive a response message containing the evaluated history and forecast; display evaluated history and forecast.

Evaluation Criteria
Confirms valid receipt and display of response message using the Juror Document.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-2.2_Response_K11_Z42
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-2.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-2.1-2015
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-2.1-2015
QPD-3 PatientList
QPD-3.1 ID Number 648286
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Stanley
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Clement
QPD-4.3 Second and Further Given Names or Initials Thereof S
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Smith
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 19500214
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 1642 Bear Run
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Boseman
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code 59715
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406
QPD-9.7 Local Number 5552020
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 648286
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID NIST MPI
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 34500907
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID IIS-AA
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Stanley
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Clement
PID-5.3 Second and Further Given Names or Initials Thereof S
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 19950101
PID-8 Administrative Sex M
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 1642 Bear Run
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Bozeman
PID-11.4 State or Province MT
PID-11.5 Zip or Postal Code 59715
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 193337027
ORC-3.2 Namespace ID IIS-AA
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier DCS
ORC-17.2 Text Dabig Clinical System
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151029
RXA-5 Administered Code
RXA-5.1 Identifier 140
RXA-5.2 Text seasonal flu
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sticker
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Nurse
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151029
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20600101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20600101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 13
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 14
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 15
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 16
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 17
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 18
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 19
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 20
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 19950101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 19950101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 26
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 20110101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 27
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 20110101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 28
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 29
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 30
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 31
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 32
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 33
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 34
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 20020101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 35
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 20020101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-2.2_Response_K11_Z42
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z42
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-2.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-2.1-2015
QAK-2 Query Response Status OK
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-2.1-2015
QPD-3 PatientList
QPD-3.1 ID Number 648286
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Stanley
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Clement
QPD-4.3 Second and Further Given Names or Initials Thereof S
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Smith
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 19500214
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 1642 Bear Run
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Boseman
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code 59715
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406
QPD-9.7 Local Number 5552020
QPD-10 Multiple birth indicator
QPD-11 Birth order

PID : Patient Identification
Location Data Element Data Categorization
PID-1 Set ID - PID 1
PID-3[1] Patient Identifier List
PID-3[1].1 ID Number 648286
PID-3[1].3 Check Digit Scheme
PID-3[1].4 Assigning Authority
PID-3[1].4.1 Namespace ID NIST MPI
PID-3[1].4.2 Universal ID
PID-3[1].4.3 Universal ID Type
PID-3[1].5 Identifier Type Code MR
PID-3[2] Patient Identifier List
PID-3[2].1 ID Number 34500907
PID-3[2].3 Check Digit Scheme
PID-3[2].4 Assigning Authority
PID-3[2].4.1 Namespace ID IIS-AA
PID-3[2].4.2 Universal ID
PID-3[2].4.3 Universal ID Type
PID-3[2].5 Identifier Type Code SR
PID-5 Patient Name
PID-5.1 Family Name
PID-5.1.1 Surname Stanley
PID-5.1.2 Own Surname Prefix
PID-5.1.3 Own Surname
PID-5.1.4 Surname Prefix From Partner/Spouse
PID-5.1.5 Surname From Partner/Spouse
PID-5.2 Given Name Clement
PID-5.3 Second and Further Given Names or Initials Thereof S
PID-5.7 Name Type Code L
PID-7 Date/Time of Birth
PID-7.1 Time 19950101
PID-8 Administrative Sex M
PID-11 Patient Address
PID-11.1 Street Address
PID-11.1.1 Street or Mailing Address 1642 Bear Run
PID-11.1.2 Street Name
PID-11.1.3 Dwelling Number
PID-11.2 Other Designation
PID-11.3 City Bozeman
PID-11.4 State or Province MT
PID-11.5 Zip or Postal Code 59715
PID-11.6 Country USA
PID-11.7 Address Type L
PID-30 Patient Death Indicator

ORC[*]
ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 193337027
ORC-3.2 Namespace ID IIS-AA
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier
ORC-17.2 Text
ORC-17.3 Name of Coding System
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

ORC : Common Order
Location Data Element Data Categorization
ORC-1 Order Control RE
ORC-2 Placer Order Number
ORC-2.1 Entity Identifier
ORC-2.2 Namespace ID
ORC-2.3 Universal ID
ORC-2.4 Universal ID Type
ORC-3 Filler Order Number
ORC-3.1 Entity Identifier 9999
ORC-3.2 Namespace ID DCS
ORC-3.3 Universal ID
ORC-3.4 Universal ID Type
ORC-17 Entering Organization
ORC-17.1 Identifier DCS
ORC-17.2 Text Dabig Clinical System
ORC-17.3 Name of Coding System HL70362
ORC-17.5 Alternate Text
ORC-17.6 Name of Alternate Coding System

RXA[*]
RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151029
RXA-5 Administered Code
RXA-5.1 Identifier 140
RXA-5.2 Text seasonal flu
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 0.5
RXA-7 Administered Units
RXA-7.1 Identifier mL
RXA-7.2 Text
RXA-7.3 Name of Coding System UCUM
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier 00
RXA-9.2 Text new immunization record
RXA-9.3 Name of Coding System NIP001
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname Sticker
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name Nurse
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID DCS_DC
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status CP

RXA : Pharmacy/Treatment Administration
Location Data Element Data Categorization
RXA-1 Give Sub-ID Counter 0
RXA-2 Administration Sub-ID Counter 1
RXA-3 Date/Time Start of Administration
RXA-3.1 Time 20151029
RXA-5 Administered Code
RXA-5.1 Identifier 998
RXA-5.2 Text no vaccine admin
RXA-5.3 Name of Coding System CVX
RXA-5.5 Alternate Text
RXA-5.6 Name of Alternate Coding System
RXA-6 Administered Amount 999
RXA-7 Administered Units
RXA-7.1 Identifier
RXA-7.2 Text
RXA-7.3 Name of Coding System
RXA-7.5 Alternate Text
RXA-7.6 Name of Alternate Coding System
RXA-9 Administration Notes
RXA-9.1 Identifier
RXA-9.2 Text
RXA-9.3 Name of Coding System
RXA-9.5 Alternate Text
RXA-9.6 Name of Alternate Coding System
RXA-10 Administering Provider
RXA-10.1 ID Number
RXA-10.2 Family Name
RXA-10.2.1 Surname
RXA-10.2.2 Own Surname Prefix
RXA-10.2.3 Own Surname
RXA-10.2.4 Surname Prefix From Partner/Spouse
RXA-10.2.5 Surname From Partner/Spouse
RXA-10.3 Given Name
RXA-10.4 Second and Further Given Names or Initials Thereof
RXA-10.9 Assigning Authority
RXA-10.9.1 Namespace ID
RXA-10.9.2 Universal ID
RXA-10.9.3 Universal ID Type
RXA-10.10 Name Type Code
RXA-10.12 Check Digit Scheme
RXA-10.13 Identifier Type Code
RXA-11 Administered-at Location
RXA-11.4 Facility
RXA-11.4.1 Namespace ID
RXA-11.4.2 Universal ID
RXA-11.4.3 Universal ID Type
RXA-18 Substance/Treatment Refusal Reason
RXA-18.1 Identifier
RXA-18.2 Text
RXA-18.3 Name of Coding System
RXA-18.5 Alternate Text
RXA-18.6 Name of Alternate Coding System
RXA-20 Completion Status NA

RXR : Pharmacy/Treatment Route
Location Data Element Data Categorization
RXR-1 Route
RXR-1.1 Identifier C28161
RXR-1.2 Text IM
RXR-1.3 Name of Coding System NCIT
RXR-1.5 Alternate Text
RXR-1.6 Name of Alternate Coding System
RXR-2 Administration Site
RXR-2.1 Identifier
RXR-2.2 Text
RXR-2.3 Name of Coding System
RXR-2.5 Alternate Text
RXR-2.6 Name of Alternate Coding System

OBX[*]
OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 1
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 2
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 3
OBX-2 Value Type ID
OBX-3 Observation Identifier
OBX-3.1 Identifier 59781-5
OBX-3.2 Text dose validity
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value Y
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time 20151029

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 4
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 5
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 6
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20600101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 7
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 1
OBX-5 Observation Value 20600101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 8
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 9
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 10
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 11
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 2
OBX-5 Observation Value 20160901
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 12
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 13
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 14
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 15
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 3
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 16
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 17
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 18
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 19
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 4
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 20
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 21
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 22
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 19950101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 23
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 5
OBX-5 Observation Value 19950101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 24
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 25
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 26
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 20110101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 27
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 6
OBX-5 Observation Value 20110101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 28
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 29
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 30
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 31
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 7
OBX-5 Observation Value 19960101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 32
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 30956-7
OBX-3.2 Text vaccine type
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 33
OBX-2 Value Type CE
OBX-3 Observation Identifier
OBX-3.1 Identifier 59779-9
OBX-3.2 Text Immunization Schedule used
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 34
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30980-7
OBX-3.2 Text Date vaccination due
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 20020101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

OBX : Observation/Result
Location Data Element Data Categorization
OBX-1 Set ID - OBX 35
OBX-2 Value Type DT
OBX-3 Observation Identifier
OBX-3.1 Identifier 30981-5
OBX-3.2 Text Earliest Date to give
OBX-3.3 Name of Coding System LN
OBX-3.5 Alternate Text
OBX-3.6 Name of Alternate Coding System
OBX-4 Observation Sub-ID 8
OBX-5 Observation Value 20020101
OBX-6 Units
OBX-6.1 Identifier
OBX-6.2 Text
OBX-6.3 Name of Coding System
OBX-6.5 Alternate Text
OBX-6.6 Name of Alternate Coding System
OBX-11 Observation Result Status F
OBX-14 Date/Time of the Observation
OBX-14.1 Time

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID IZ-QR-2_Query_Adult
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
648286 Clement S Stanley 01/01/1995 Male
When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient.


Evaluated Immunization History and Immunization Forecast
Immunization Schedule Used Tester Comment
ACIP


Evaluated Immunization History
Vaccine Group Vaccine Administered Date Administered Valid Dose Validity Reason Completion Status* Tester Comment
influenza NOS seasonal flu 10/29/2015 YES Complete
* "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered".


Immunization Forecast
Vaccine Group Due Date Earliest Date To Give Latest Date to Give Tester Comment
pcv NOS 01/01/2060 01/01/2060
influenza NOS 09/01/2016 09/01/2016
MMR 01/01/1996 01/01/1996
Hep A 01/01/1996 01/01/1996
Hep B 01/01/1995 01/01/1995
MCV 01/01/2011 01/01/2011
varicella 01/01/1996 01/01/1996
TDAP 01/01/2002 01/01/2002

2.3. IZ-QR-3_Query_No_Patients

Tests ability to send a query and receive a response where no patients are found.

Test Story

Description
A female toddler, Donna Victoria Bee, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth, sex, and birth order (Donna was born 3rd in a triplet). A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient.

The IIS performs a search for Donna Victoria Bee and does not find a high-confidence match. The IIS returns a response message indicating no person found to the querying system. It is expected that the requesting system (e.g., EHR-S) process the response message and display some indication to the end user that no matches were found.

Comments
No Comments

Pre Condition
Person exists in the system with the complete demographics as provided in the Test Data Specification.
Person has Medical Record Number (MR).
Person does not have a record in the IIS, even though complete demographics are used in the query.

Post Condition
The clinician is provided some indication that no matches were found.

Test Objectives
Tests for a maximally valued query message, including use of OIDs, mother's maiden name, fully valued address, birth indicator and birth order. Test the capability of the EHR-S to process a response message that returns no persons found and to provide an indication to the end user.

Evaluation Criteria
Query Message: Message Validation Report
Response Message: Juror Document. The EHR-S receives the response and alerts the clinician that no matches were found.

Notes for Testers
The NIST tool is simulating a response from the IIS.

2.3.1. IZ-QR-3.1_Query_Q11_Z44

This query should return a response where no matches are found.

Test Story

Description
A female toddler, Donna Victoria Bee, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth, sex, and birth order (Donna was born 3rd in a triplet). A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient.

Comments
Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record.
The sending (querying) system will need to accept a response indicating that no matches were found.

Pre Condition
Person exists in the system with the complete demographics as provided in the Test Data Specification.
Person has Medical Record Number (MR).
Person does not have a record in the IIS, even though complete demographics are used in the query.

Post Condition
A response message is returned in which no person record is found.

Test Objectives
Tests for a maximally valued query message, including use of OIDs, mother's maiden name, fully valued address, birth indicator and birth order.

Evaluation Criteria
Message Validation Report

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.22 Indifferent
MSH-3.3 Universal ID Type ISO Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.23 Indifferent
MSH-4.3 Universal ID Type ISO Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1 Indifferent
MSH-5.3 Universal ID Type ISO Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2 Indifferent
MSH-6.3 Universal ID Type ISO Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150531145156-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-22.6.3 Universal ID Type ISO Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6478 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-23.6.3 Universal ID Type ISO Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-6478 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-3.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 177993 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID 2.16.840.1.113883.3.72.5.30.2 Indifferent
QPD-3.4.3 Universal ID Type ISO Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Bee Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Donna Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Victoria Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Goluchio Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20120507 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 737 Everygreen Road Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Suite 511 Indifferent
QPD-8.3 City Livingston Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 59047 Value-Test Case Fixed
QPD-8.6 Country USA Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406 Value-Test Case Fixed
QPD-9.7 Local Number 5553758 Value-Test Case Fixed
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 3 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.22 Indifferent
MSH-3.3 Universal ID Type ISO Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.23 Indifferent
MSH-4.3 Universal ID Type ISO Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.40.1 Indifferent
MSH-5.3 Universal ID Type ISO Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.40.2 Indifferent
MSH-6.3 Universal ID Type ISO Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150531145156-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-22.6.3 Universal ID Type ISO Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6478 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID 2.16.840.1.113883.3.72.5.30.1 Indifferent
MSH-23.6.3 Universal ID Type ISO Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-6478 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-3.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 177993 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID 2.16.840.1.113883.3.72.5.30.2 Indifferent
QPD-3.4.3 Universal ID Type ISO Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Bee Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Donna Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Victoria Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Goluchio Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20120507 Value-Test Case Fixed
QPD-7 Patient Sex F Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 737 Everygreen Road Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Suite 511 Indifferent
QPD-8.3 City Livingston Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 59047 Value-Test Case Fixed
QPD-8.6 Country USA Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406 Value-Test Case Fixed
QPD-9.7 Local Number 5553758 Value-Test Case Fixed
QPD-10 Multiple birth indicator Y Value-Test Case Fixed
QPD-11 Birth order 3 Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name Donna Victoria Bee
Mother's Maiden Name Goluchio
ID Number 177993
Date/Time of Birth 05/07/2012
Sex Female
Patient Address 737 Everygreen Road Livingston MT 59047 USA
Patient Phone (406)555-3758
Birth Indicator Y
Birth Order 3
Patient Information
Element Data
Patient Name Donna Victoria Bee
Mother's Maiden Name Goluchio
ID Number 177993
Date/Time of Birth 05/07/2012
Sex Female
Patient Address 737 Everygreen Road Livingston MT 59047 USA
Patient Phone (406)555-3758
Birth Indicator Y
Birth Order 3

2.3.2. IZ-QR-3.2_Response_NF_K11_Z33

Response with no matches found

Test Story

Description
The IIS performs a search for Donna Victoria Bee and does not find a high-confidence match. The IIS returns a response message indicating no person found to the querying system.

Comments
No Comments

Pre Condition
The patient Donna Victoria Bee exists in the querying system (e.g., EHR-S) and a query was performed. The IIS (simulated by the NIST test tool) does not find a match for the person.

Post Condition
The response message is processed and the clinician is alerted to fact of no matches.

Test Objectives
Test the capability of the EHR-S to process a response message that returns no persons found and to provide an indication to the end user.

Evaluation Criteria
Juror Document. Clinician is notified of no match.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.22
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.23
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20151031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-3.2_Respons_NF_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-3.1-2015
QAK-2 Query Response Status NF
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-3.1-2015
QPD-3 PatientList
QPD-3.1 ID Number 177993
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID 2.16.840.1.113883.3.72.5.30.2
QPD-3.4.3 Universal ID Type ISO
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Bee
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Donna
QPD-4.3 Second and Further Given Names or Initials Thereof Victoria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Goluchio
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20120507
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 737 Everygreen Road
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Suite 511
QPD-8.3 City Livingston
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code 59047
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406
QPD-9.7 Local Number 5553758
QPD-10 Multiple birth indicator Y
QPD-11 Birth order 3

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID 2.16.840.1.113883.3.72.5.40.1
MSH-3.3 Universal ID Type ISO
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID 2.16.840.1.113883.3.72.5.40.2
MSH-4.3 Universal ID Type ISO
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID 2.16.840.1.113883.3.72.5.22
MSH-5.3 Universal ID Type ISO
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID 2.16.840.1.113883.3.72.5.23
MSH-6.3 Universal ID Type ISO
MSH-7 Date/Time Of Message
MSH-7.1 Time 20151031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-3.2_Respons_NF_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-QR-3.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-3.1-2015
QAK-2 Query Response Status NF
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-3.1-2015
QPD-3 PatientList
QPD-3.1 ID Number 177993
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID 2.16.840.1.113883.3.72.5.30.2
QPD-3.4.3 Universal ID Type ISO
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Bee
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name Donna
QPD-4.3 Second and Further Given Names or Initials Thereof Victoria
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Goluchio
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code M
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20120507
QPD-7 Patient Sex F
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 737 Everygreen Road
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Suite 511
QPD-8.3 City Livingston
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code 59047
QPD-8.6 Country USA
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406
QPD-9.7 Local Number 5553758
QPD-10 Multiple birth indicator Y
QPD-11 Birth order 3

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID IZ-QR-3_Query_No_Patients
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are petermitted to be displayed by the EHR.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
177993 Donna Victoria Bee 05/07/2012 Female
When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record.


Evaluated Immunization History and Immunization Forecast
The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query.

2.4. IZ-QR-4_Query_Too_Many

Query finds too many matches

Test Story

Description
A child, James Smith, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient.

The IIS performs a search for James Smith and finds too many matches. The IIS returns a response message indicating no person found (too many matches) to the querying system. It is expected that the requesting system (e.g., EHR-S) process the response message and display some indication to the end user that the person was not found (too many matches).

Comments


Pre Condition
Person exists in the system with the complete demographics as provided in the Test Data Specification.

Person has Medical Record Number (MR).

Person may have a record in the IIS, however the IIS is unable narrow the search results to a single match (multiple matches exist).

Post Condition
The clinician is provided some indication that too many matches were found.

Test Objectives
Tests for a typically valued query message. Test the capability of the EHR-S to process a response message that returns no persons found (too many matches) and to provide an indication to the end user.

Evaluation Criteria
Query Message: Message Validation Report
Response Message: Juror Document. The EHR-S receives the response and alerts the clinician that too many matches were found.

Notes for Testers
The NIST tool is simulating a response from the IIS.

2.4.1. IZ-QR-4.1_Query_Q11_Z44

Query will find too many matches

Test Story

Description
A child, James Smith, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient.

Comments
Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record.

The sending (querying) system will need to accept a response indicating that too many matches were found.

Pre Condition
More than one person in the IIS matching the parameters in the query exists.

Post Condition
Response indicates that there are more than one match (too many) and the clinician is informed.

Test Objectives
Tests for a typically valued query message.

Evaluation Criteria
Message Validation Report

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150531145156-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-4.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST EHR Facility Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6482 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST IIS FAC Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-1776 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-4.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 412299 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID Indifferent
QPD-3.4.3 Universal ID Type Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Smith Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name James Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20110905 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 22 East Branch Way Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Indifferent
QPD-8.3 City Livingston Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 59047 Value-Test Case Fixed
QPD-8.6 Country Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406 Value-Test Case Fixed
QPD-9.7 Local Number 5556285 Value-Test Case Fixed
QPD-10 Multiple birth indicator Value-Test Case Fixed
QPD-11 Birth order Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator | Value-Profile Fixed
MSH-2 Encoding Characters ^~\& Value-Profile Fixed
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST EHR APP Presence-Configuration
MSH-3.2 Universal ID Indifferent
MSH-3.3 Universal ID Type Indifferent
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST EHR Facility Presence-Configuration
MSH-4.2 Universal ID Indifferent
MSH-4.3 Universal ID Type Indifferent
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST IIS APP Presence-Configuration
MSH-5.2 Universal ID Indifferent
MSH-5.3 Universal ID Type Indifferent
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST IIS FAC Presence-Configuration
MSH-6.2 Universal ID Indifferent
MSH-6.3 Universal ID Type Indifferent
MSH-7 Date/Time Of Message
MSH-7.1 Time 20150531145156-0500 Presence-System Generated
MSH-9 Message Type
MSH-9.1 Message Code QBP Value-Profile Fixed
MSH-9.2 Trigger Event Q11 Value-Profile Fixed
MSH-9.3 Message Structure QBP_Q11 Value-Profile Fixed
MSH-10 Message Control ID NIST-IZ-4.1_Query_Q11_Z44 Presence-System Generated
MSH-11 Processing ID
MSH-11.1 Processing ID P Presence-Content Indifferent
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1 Value-Profile Fixed
MSH-15 Accept Acknowledgment Type ER Value-Profile Fixed
MSH-16 Application Acknowledgment Type AL Value-Profile Fixed
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z44 Value-Test Case Fixed
MSH-21.2 Namespace ID CDCPHINVS Value-Profile Fixed
MSH-21.3 Universal ID Indifferent
MSH-21.4 Universal ID Type Indifferent
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST EHR Facility Presence-Configuration
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-22.6.2 Universal ID Indifferent
MSH-22.6.3 Universal ID Type Indifferent
MSH-22.7 Identifier Type Code XX Indifferent
MSH-22.10 Organization Identifier 100-6482 Indifferent
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST IIS FAC Presence-Configuration
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1 Indifferent
MSH-23.6.2 Universal ID Indifferent
MSH-23.6.3 Universal ID Type Indifferent
MSH-23.7 Identifier Type Code XX Indifferent
MSH-23.10 Organization Identifier 100-1776 Indifferent

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44 Value-Test Case Fixed
QPD-1.2 Text Request Evaluated History and Forecast Value-Test Case Fixed
QPD-1.3 Name of Coding System CDCPHINVS Value-Profile Fixed
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-4.1-2015 Presence-System Generated
QPD-3 PatientList
QPD-3.1 ID Number 412299 Value-Test Case Fixed
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI Value-Test Case Fixed
QPD-3.4.2 Universal ID Indifferent
QPD-3.4.3 Universal ID Type Indifferent
QPD-3.5 Identifier Type Code MR Value-Test Case Fixed
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Smith Value-Test Case Fixed
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name James Value-Test Case Fixed
QPD-4.3 Second and Further Given Names or Initials Thereof Value-Test Case Fixed
QPD-4.7 Name Type Code L Value-Test Case Fixed
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname Value-Test Case Fixed
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code Value-Profile Fixed
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20110905 Value-Test Case Fixed
QPD-7 Patient Sex M Value-Test Case Fixed
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 22 East Branch Way Value-Test Case Fixed
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation Indifferent
QPD-8.3 City Livingston Value-Test Case Fixed
QPD-8.4 State or Province MT Value-Test Case Fixed
QPD-8.5 Zip or Postal Code 59047 Value-Test Case Fixed
QPD-8.6 Country Value-Test Case Fixed
QPD-8.7 Address Type L Presence-Content Indifferent
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN Value-Test Case Fixed
QPD-9.3 Telecommunication Equipment Type PH Value-Test Case Fixed
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406 Value-Test Case Fixed
QPD-9.7 Local Number 5556285 Value-Test Case Fixed
QPD-10 Multiple birth indicator Value-Test Case Fixed
QPD-11 Birth order Value-Test Case Fixed

RCP : Response Control Parameter
Location Data Element Data Categorization
RCP-1 Query Priority I Value-Profile Fixed
RCP-2 Quantity Limited Request
RCP-2.1 Quantity 1 Value-Test Case Fixed
RCP-2.2 Units
RCP-2.2.1 Identifier RD Value-Profile Fixed
RCP-2.2.2 Text Records Value-Profile Fixed
RCP-2.2.3 Name of Coding System HL70126 Value-Profile Fixed
RCP-2.2.4 Alternate Identifier
RCP-2.2.5 Alternate Text
RCP-2.2.6 Name of Alternate Coding System

Test Data Specification

Patient Information
Element Data
Patient Name James Smith
Mother's Maiden Name
ID Number 412299
Date/Time of Birth 09/05/2011
Sex Male
Patient Address 22 East Branch Way Livingston MT 59047
Patient Phone (406)555-6285
Birth Indicator
Birth Order
Patient Information
Element Data
Patient Name James Smith
Mother's Maiden Name
ID Number 412299
Date/Time of Birth 09/05/2011
Sex Male
Patient Address 22 East Branch Way Livingston MT 59047
Patient Phone (406)555-6285
Birth Indicator
Birth Order

2.4.2. IZ-QR-4.2_Response_TM_K11_Z33

Response message indicating that too matches were found.

Test Story

Description
The IIS performs a search for James Smith and finds too many matches based on the sending system's query (e.g., EHR-S). The IIS returns a response message indicating no person found (too many matches) to the querying system. It is expected that the requesting system (e.g., EHR-S) process the response message and display some indication to the end user that the person was not found (too many matches).

Comments
No Comments

Pre Condition
A query is made to the IIS. Person may have a record in the IIS, however the IIS is unable narrow the search results to a single match (multiple matches exist).

Post Condition
The clinician is provided some indication that too many matches were found.

Test Objectives
Test the capability of the EHR-S to process a response message that returns no persons found (too many matches) and to provide an indication to the end user.

Evaluation Criteria
Juror Document. Clinician is notified that too many matches were found.

Notes for Testers
No Note

Message Contents

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-4.2_Response_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-4.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-4.1-2015
QAK-2 Query Response Status TM
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-4.1-2015
QPD-3 PatientList
QPD-3.1 ID Number 412299
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Smith
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name James
QPD-4.3 Second and Further Given Names or Initials Thereof
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20110905
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 22 East Branch Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Livingston
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code 59047
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406
QPD-9.7 Local Number 5556285
QPD-10 Multiple birth indicator
QPD-11 Birth order

MSH : Message Header
Location Data Element Data Categorization
MSH-1 Field Separator |
MSH-2 Encoding Characters ^~\&
MSH-3 Sending Application
MSH-3.1 Namespace ID NIST IIS APP
MSH-3.2 Universal ID
MSH-3.3 Universal ID Type
MSH-4 Sending Facility
MSH-4.1 Namespace ID NIST IIS FAC
MSH-4.2 Universal ID
MSH-4.3 Universal ID Type
MSH-5 Receiving Application
MSH-5.1 Namespace ID NIST EHR APP
MSH-5.2 Universal ID
MSH-5.3 Universal ID Type
MSH-6 Receiving Facility
MSH-6.1 Namespace ID NIST EHR Facility
MSH-6.2 Universal ID
MSH-6.3 Universal ID Type
MSH-7 Date/Time Of Message
MSH-7.1 Time 20141031145233-0500
MSH-9 Message Type
MSH-9.1 Message Code RSP
MSH-9.2 Trigger Event K11
MSH-9.3 Message Structure RSP_K11
MSH-10 Message Control ID NIST-IZ-QR-4.2_Response_K11_Z33
MSH-11 Processing ID
MSH-11.1 Processing ID P
MSH-12 Version ID
MSH-12.1 Version ID 2.5.1
MSH-15 Accept Acknowledgment Type NE
MSH-16 Application Acknowledgment Type NE
MSH-21 Message Profile Identifier
MSH-21.1 Entity Identifier Z33
MSH-21.2 Namespace ID CDCPHINVS
MSH-21.3 Universal ID
MSH-21.4 Universal ID Type
MSH-22 Sending Responsible Organization
MSH-22.1 Organization Name NIST IIS FAC
MSH-22.6 Assigning Authority
MSH-22.6.1 Namespace ID NIST-AA-1
MSH-22.6.2 Universal ID
MSH-22.6.3 Universal ID Type
MSH-22.7 Identifier Type Code XX
MSH-22.10 Organization Identifier 100-1776
MSH-23 Receiving Responsible Organization
MSH-23.1 Organization Name NIST EHR Facility
MSH-23.6 Assigning Authority
MSH-23.6.1 Namespace ID NIST-AA-1
MSH-23.6.2 Universal ID
MSH-23.6.3 Universal ID Type
MSH-23.7 Identifier Type Code XX
MSH-23.10 Organization Identifier 100-6482

MSA : Message Acknowledgment
Location Data Element Data Categorization
MSA-1 Acknowledgment Code AA
MSA-2 Message Control ID NIST-IZ-4.1_Query_Q11_Z44

QAK : Query Acknowledgment
Location Data Element Data Categorization
QAK-1 Query Tag IZ-4.1-2015
QAK-2 Query Response Status TM
QAK-3 Message Query Name
QAK-3.1 Identifier Z44
QAK-3.2 Text request evaluated Immunization history
QAK-3.3 Name of Coding System CDCPHINVS
QAK-3.5 Alternate Text
QAK-3.6 Name of Alternate Coding System

QPD : Query Parameter Definition
Location Data Element Data Categorization
QPD-1 Message Query Name
QPD-1.1 Identifier Z44
QPD-1.2 Text Request Evaluated History and Forecast
QPD-1.3 Name of Coding System CDCPHINVS
QPD-1.5 Alternate Text
QPD-1.6 Name of Alternate Coding System
QPD-2 Query Tag IZ-4.1-2015
QPD-3 PatientList
QPD-3.1 ID Number 412299
QPD-3.3 Check Digit Scheme
QPD-3.4 Assigning Authority
QPD-3.4.1 Namespace ID NIST MPI
QPD-3.4.2 Universal ID
QPD-3.4.3 Universal ID Type
QPD-3.5 Identifier Type Code MR
QPD-4 PatientName
QPD-4.1 Family Name
QPD-4.1.1 Surname Smith
QPD-4.1.2 Own Surname Prefix
QPD-4.1.3 Own Surname
QPD-4.1.4 Surname Prefix From Partner/Spouse
QPD-4.1.5 Surname From Partner/Spouse
QPD-4.2 Given Name James
QPD-4.3 Second and Further Given Names or Initials Thereof
QPD-4.7 Name Type Code L
QPD-5 PatientMotherMaidenName
QPD-5.1 Family Name
QPD-5.1.1 Surname
QPD-5.1.2 Own Surname Prefix
QPD-5.1.3 Own Surname
QPD-5.1.4 Surname Prefix From Partner/Spouse
QPD-5.1.5 Surname From Partner/Spouse
QPD-5.7 Name Type Code
QPD-6 PatientDateOfBirth
QPD-6.1 Time 20110905
QPD-7 Patient Sex M
QPD-8 Patient Address
QPD-8.1 Street Address
QPD-8.1.1 Street or Mailing Address 22 East Branch Way
QPD-8.1.2 Street Name
QPD-8.1.3 Dwelling Number
QPD-8.2 Other Designation
QPD-8.3 City Livingston
QPD-8.4 State or Province MT
QPD-8.5 Zip or Postal Code 59047
QPD-8.6 Country
QPD-8.7 Address Type L
QPD-9 Phone
QPD-9.2 Telecommunication Use Code PRN
QPD-9.3 Telecommunication Equipment Type PH
QPD-9.4 Email Address
QPD-9.6 Area/City Code 406
QPD-9.7 Local Number 5556285
QPD-10 Multiple birth indicator
QPD-11 Birth order

Test Data Specification

Patient Information
Element Data
This information will be automatically supplied by the System

Patient Information
Element Data
This information will be automatically supplied by the System

Juror Document

Evaluated Immunization History and Immunization Forecast
Test Case ID IZ-QR-4_Query_Too_Many
Juror ID
Juror Name
HIT System Tested
Inspection Date/Time
Inspection Settlement (Pass/Fail)
Pass Fail
Reason Failed
Juror Comments

DISPLAY VERIFICATION

This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.

The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.

The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.



Patient Information
Patient Identifier Patient Name DOB Gender Tester Comment
412299 James Smith 09/05/2011 Male
When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record.


Evaluated Immunization History and Immunization Forecast
The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query.